Chlorhexidine-Based Solutions May Be Preferred to Prevent Catheter-Related Infection

October 25, 2007 — Chlorhexidine-based solutions should be considered as a replacement for povidone-iodine formulations, including those that are alcohol based, in efforts to prevent central venous catheter–related infection, according to the results of a study reported in the October 22 issue of the Archives of Internal Medicine.
"Although chlorhexidine-based solutions and alcohol-based povidone-iodine have been shown to be more efficient than aqueous povidone-iodine for skin disinfection at catheter insertion sites, their abilities to reduce catheter-related infection have never been compared," write Olivier Mimoz, MD, PhD, from Centre Hospitalier et Universitaire de Poitiers in France, and colleagues. "Catheter-related bloodstream infections have been reported to occur in 3% to 8% of catheters inserted and are the predominant cause of nosocomial bacteremia in intensive care units (ICUs), with 80,000 cases annually at a cost of $300 million to $2.3 billion."
In this study, 538 consecutively scheduled central venous catheters inserted into jugular or subclavian veins were randomized to be disinfected with 5% povidone-iodine in 70% ethanol or with a combination of 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzylic alcohol. These solutions were used before catheter insertion for skin disinfection with 2 consecutive 30-second applications, allowing the skin to dry in between, as well as for single applications during subsequent dressing changes, which were performed every 72 hours or sooner if the dressing became soiled or wet.
Culture results were evaluable in 481 (89.4%) of catheters studied. Compared with use of povidone-iodine, the chlorhexidine-based solution was associated with a 50% reduction in the incidence of catheter colonization (11.6% vs 22.2%; P =.002; incidence density, 9.7 vs 18.3 per 1000 catheter-days). There was also a statistically nonsignificant trend toward lower rates of catheter-related bloodstream infection (1.7% vs 4.2%; P =. 09; incidence density, 1.4 vs 3.4 per 1000 catheter-days).
Risk factors that were independently associated with catheter colonization were catheter insertion into the jugular vein (adjusted relative risk [RR], 2.01; 95% confidence interval [CI], 1.24 - 3.24) and use of povidone-iodine (adjusted RR, 1.87; 95% CI, 1.18 - 2.96).
"Chlorhexidine-based solutions should be considered as a replacement for povidone-iodine (including alcohol-based) formulations in efforts to prevent catheter-related infection," the study authors write.
Limitations of the study include lack of blinding, treatment groups not equally distributed with regard to sex, and insufficient power to demonstrate a significant reduction of catheter-related bloodstream infection.
"Our results demonstrate that the use of a chlorhexidine-based solution rather than povidone-iodine is likely to result in decreased catheter colonization," the study authors conclude. "Given the extent of the benefit and the absence of incremental cost, chlorhexidine-based solutions should be considered as a replacement for povidone-iodine (including alcohol-based formulations) in efforts to prevent catheter-related infection."
Centre Hospitalier et Universitaire de Poitiers, Bayer HealthCare, and Viatris Pharmaceuticals supported this study. Dr. Mimoz has served as a consultant to Bayer HealthCare and Viatris Pharmaceuticals.
Arch Intern Med. 2007;167:2066-2072.