Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-12-03T15:06:54.606Z Has data issue: false hasContentIssue false

Skin Antisepsis Kits Containing Alcohol and Chlorhexidine Gluconate or Tincture of Iodine are Associated With Low Rates of Blood Culture Contamination

Published online by Cambridge University Press:  02 January 2015

Barbara W. Trautner
Affiliation:
Department of Medicine, Infectious Diseases Section, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
Jill E. Clarridge
Affiliation:
Department of Pathology, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
Rabih O. Darouiche*
Affiliation:
Department of Medicine, Infectious Diseases Section, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas Department of Physical Medicine and Rehabilitation, Center for Prosthesis Infection, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
*
Center for Prosthesis Infection, Baylor College of Medicine, 1333 Moursund Avenue, Suite A221, Houston, TX 77030

Abstract

Objective:

Skin preparation is an important factor in reducing the rate of blood culture contamination. We assessed blood culture contamination rates associated with the use of skin antisepsis kits containing either 2% alcoholic chlorhexidine gluconate or 2% alcoholic tincture of iodine.

Design:

Prospective, blinded clinical trial.

Setting:

Tertiary-care teaching hospital.

Patients:

Adult patients in medical wards, the medical intensive care unit, and the cardiac intensive care unit who needed paired, percutaneous blood cultures.

Interventions:

House officers, medical students, and healthcare technicians drew the blood for cultures. We prepared sacks containing all of the necessary supplies, including two different types of antiseptic kits. In each sack, one kit contained 2% chlorhexidine in 70% isopropyl alcohol and the other contained 2% tincture of iodine in ethyl alcohol and 70% isopropyl alcohol. Each patient received chlorhexidine at one site and tincture of iodine at the other.

Results:

Four (0.9%) of 430 blood culture sets from 215 patients were contaminated. The contamination rate when using alcohol and chlorhexidine (1 of 215, 0.5%) did not differ significantly from the contamination rate when using tincture of iodine (3 of 215,1.4%; P = .62, McNemar test). There was an 87% probability that the two interventions differed by less than 2% in their rate of contamination.

Conclusions:

Both of these antiseptic kits were highly effective for skin preparation prior to drawing blood for cultures. The use of these kits may have contributed to the low contamination rate observed in this study.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Souvenir, D, Anderson, DE Jr, Palpant, S, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 1998;36:19231926.Google Scholar
2.Waltzman, ML, Harper, M. Financial and clinical impact of false-positive blood culture results. Clin Infect Dis 2001;33:296299.Google Scholar
3.Schifman, RB, Pindur, A. The effect of skin disinfection materials on reducing blood culture contamination. Am J Clin Pathol 1993;99:536538.Google Scholar
4.Little, JR, Murray, PR, Traynor, PS, Spitznagel, E. A randomized trial of povidone-iodine compared with iodine tincture for venipuncture site disinfection: effects on rates of blood culture contamination. Am J Med 1999;107:119125.Google Scholar
5.Isaacman, DJ, Karasic, RB. Lack of effect of changing needles on contamination of blood cultures. Pediatr Infect Dis J 1990;9:274278.CrossRefGoogle ScholarPubMed
6.Strand, CL, Wajsbort, RR, Sturmann, K. Effect of iodophor vs iodine tincture skin preparation on blood culture contamination rate. JAMA 1993;269:10041006.Google Scholar
7.Wilson, ML, Weinstein, MP, Mirrett, S, et al. Comparison of iodophor and alcohol pledgets with the Medi-Flex Blood Culture Prep Kit II for preventing contamination of blood cultures. J Clin Microbiol 2000;38:46654667.CrossRefGoogle Scholar
8.Weinstein, MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis 1996;23:4046.CrossRefGoogle ScholarPubMed
9.Mylotte, JM, Tayara, A. Blood cultures: clinical aspects and controversies. Eur J Clin Microbiol Infect Dis 2000;19:157163.Google Scholar
10.Ernst, DJ. The right way to do blood cultures. RN 2001;64:2831.Google Scholar
11.Crosby, CT, Mares, AK. Skin antisepsis: past, present, and future. Journal of Vascular Access Devices 2001:16.Google Scholar
12.King, TC, Price, PB. An evaluation of iodophors as skin antiseptics. Surg Gynecol Obstet 1963;116:361365.Google Scholar
13.Lee, S, Schoen, I, Malkin, A. Comparison of use of alcohol with that of iodine for skin antisepsis in obtaining blood cultures. Am J Clin Pathol 1967;47:646648.Google Scholar
14.Mimoz, O, Karim, A, Mercat, Aet al. Chlorhexidine compared with povidone-iodine as skin preparation before blood culture: a randomized, controlled trial. Ann Intern Med 1999;131:834837.Google Scholar
15.Denton, GW. Chlorhexidine. In: Block, SS, ed. Disinfection, Sterilization and Preservation. Philadelphia: Lea & Febiger; 1991:274289.Google Scholar
16.Maki, DG, Ringer, M, Alvarado, CJ. Prospective, randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339343.Google Scholar
17.Schifman, RB, Strand, CL, Meier, FAHowanitz, PJ. Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med 1998;122:216221.Google Scholar
18.Weinbaum, FI, Lavie, S, Danek, M, Sixsmith, D, Heinrich, GF, Mills, SS. Doing it right the first time: quality improvement and the contaminant blood culture. J Clin Microbiol 1997;35:563565.Google Scholar
19.Gibb, AP, Hill, B, Chorel, B, Brant, R. Reduction in blood culture contamination rate by feedback to phlebotomists. Arch Pathol Lab Med 1997; 121:503507.Google Scholar
20.Weinstein, MP, Towns, ML, Quartey, SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584602.Google Scholar
21.Washington, JA. Collection, transport, and processing of blood cultures. Clin Lab Med 1994;14:5968.Google Scholar