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Intensive Care Med. 2016 Sep;42(9):1418-26. doi: 10.1007/s00134-016-4406-4. Epub 2016 Jun 16.

Comparison of alcoholic chlorhexidine and povidone-iodine cutaneous antiseptics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study.

Author information

1
Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France.
2
Department of Intensive Care Medicine, General Hospital, Saint Lô, France.
3
Department of Medial and Toxicologic Intensive Care, Lariboisière University Hospital, Paris, France.
4
Department of Intensive Care Medicine, Caen University Hospital, Caen, France.
5
EA4655 Risque Microbiens, Caen Normandie Université, Caen, France.
6
Department of Intensive Care Medicine, General Hospital, Pontoise, France.
7
Warren Alpert Medical School of Brown University, Providence, RI, USA.
8
Department of Medial Intensive Care, Cochin University Hospital, Paris, France.
9
Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France. parienti-jj@chu-caen.fr.
10
EA4655 Risque Microbiens, Caen Normandie Université, Caen, France. parienti-jj@chu-caen.fr.
11
Department of Infectious Diseases, Caen University Hospital, Caen, France. parienti-jj@chu-caen.fr.

Abstract

PURPOSE:

Compare the effectiveness of different cutaneous antiseptics in reducing risk of catheter-related infection in intensive care unit (ICU) patients.

METHODS:

We compared the risk of central venous catheter-related infection according to four-step (scrub, rinse, dry, and disinfect) alcoholic 5 % povidone-iodine (PVI-a, n = 1521), one-step (disinfect) alcoholic 2 % chlorhexidine (2 % CHX-a, n = 1116), four-step alcoholic <1 % chlorhexidine (<1 % CHX-a, n = 357), and four-step aqueous 10 % povidone-iodine (PVI, n = 368) antiseptics used for cutaneous disinfection and catheter care during the 3SITES multicenter randomized controlled trial. Within this cohort, we performed a quasi-experimental study (i.e., before-after) involving the four ICUs which switched from PVI-a to 2 % CHX-a. We used propensity score matching (PSM, n = 776) and inverse probability weighting treatment (IPWT, n = 1592). The end point was the incidence of catheter-related infection (CRI) defined as catheter-related bloodstream infection (CRBSI) or a positive catheter tip culture plus clinical sepsis on catheter removal.

RESULTS:

In the cohort analysis and compared with PVI-a, the incidence of CRI was lower with 2 % CHX-a [adjusted hazard ratio (aHR), 0.51; 95 % confidence interval (CI) (0.28-0.96), p = 0.037] and similar with <1 % CHX-a [aHR, 0.73; (0.36-1.48), p = 0.37] and PVI [aHR, 1.50; 95 % CI (0.85-2.64), p = 0.16] after controlling for potential confounders. In the quasi-experimental study and compared with PVI-a, the incidence of catheter-related infection was again lower with 2 % CHX-a after PSM [HR, 0.35; 95 % CI (0.15, 0.84), p = 0.02] and in the IPWT analysis [HR, 0.31; 95 % CI (0.14, 0.70), p = 0.005]. The incidence of CRBSI or adverse event was not significantly different between antiseptics in all analyses.

CONCLUSIONS:

In comparison with PVI-a, the use of 2 % CHX-a for cutaneous disinfection of the central venous catheter insertion site and maintenance catheter care was associated with a reduced risk of catheter infection, while the benefit of <1 % CHX-a was uncertain.

CLINICAL TRIALS IDENTIFIER:

NCT01479153.

KEYWORDS:

Central venous catheter; Chlorhexidine; Cutaneous disinfection; Nosocomial infection; Povidone–iodine

PMID:
27311311
DOI:
10.1007/s00134-016-4406-4
[Indexed for MEDLINE]

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