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Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients

  • J. Vallés (a1), I. Fernández (a1), D. Alcaraz (a1), E. Chacón (a1), A. Cazorla (a1), M. Canals (a1), D. Mariscal (a2), D. Fontanals (a2) and A. Morón (a3)...

Abstract

Objective.

To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).

Design.

Prospective, randomized controlled trial.

Setting.

Intensive care unit in a teaching hospital.

Methods.

Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.

Results.

A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1 % vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.

Conclusions.

The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.

Copyright

Corresponding author

Critical Care Center, Hospital Sabadell, Pare Tauli s/n, 08208 Sabadell, Spain (jvalles@cspt.es)

References

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1.Raad, I. Intravascular-catheter-related infections. Lancet 1998;351:893898.
2.Smith, RL, Meixler, SM, Simberkoff, MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 1991;100:164167.
3.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:15981601.
4.Vallés, J, León, C, Alvarez-Lerma, F; Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Espanola de Medicina Intensiva y Unidades Coronarias (SEMIUC). Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Clin Infect Dis 1997;24:387395.
5.Jarvis, WR, Edwards, J, Culver, DH, et al.Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(Suppl 3B):185S191S.
6.Renaud, B, Brun-Buisson, C; ICU-Bacteremia Study Group. Outcomes of primary and catheter.related bacteremia: a cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 2001;163:15841590.
7.Blot, SI, Depuydt, P, Annemans, L, et al.Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005;41:15911598.
8.Raad, I, Hohn, DC, Gillbreath, BJ, et al.Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994;15:231238.
9.Maki, DG, Ringer, M, Alvarado, CJ. Prospective, randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339343.
10.Mimoz, O, Pieroni, L, Lawrence, C, et al.Prospective, randomized trial of two antiseptic solutions for prevention of central venous and arterial catheter colonization and infection in intensive care patients. Crit Care Med 1996;24:18181823.
11.Chaiyakunapruk, N, Veenstra, DL, Lipsky, BA, Saint, S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002;136:792801.
12.O'Grady, NP, Alexander, M, Patchen Dellinger, E, et al.Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2002;35:12811307.
13.Parienti, JJ, du Chevron, D, Ramakers, M, et al.Alcoholic povidone-iodine to prevent central venous catheter colonization: a randomized unit-crossover study. Crit Care Med 2004;32:708713.
14.Mimoz, O, Villeminey, S, Ragot, S, et al.Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med 2007;167:20662072.
15.Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous catheter related infection. N Engl J Med 1977;296:13051309.
16.Murray, PR, Baron, EJ, Jorgensen, JH, Phaller, MA, Yolken, RH, eds. Manual of Clinical Microbiology. 8th ed. Washington, DC: ASM Press; 2003.
17.Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 14th and 16th informational supplements. CLSI document. Wayne, PA: CLSI, 2005 and 2006:M100-S15/S16.
18.Safdar, N, Maki, DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30:6267.
19.Humar, A, Ostromecki, A, Direnfeld, J, et al.Prospective ranzomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection. Clin Infect Dis 2000;31:10011007.
20.Shelton, DM. A comparison of the effects of two antiseptic agents on Staphylococcus epidermidis colony forming units at the peritoneal dialysis catheter exit site. Adv Perit Dial 1991;7:120124.
21.Rijnders, BJA, Van Wijngaerden, E, Peetermans, WE. Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? Clin Infect Dis 2002;35:10531058.

Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients

  • J. Vallés (a1), I. Fernández (a1), D. Alcaraz (a1), E. Chacón (a1), A. Cazorla (a1), M. Canals (a1), D. Mariscal (a2), D. Fontanals (a2) and A. Morón (a3)...

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