Prospective, randomised trial of three antiseptic solutions for prevention of central venous or arterial catheter colonisation in intensive care unit patients
Abstract number: 1733_1198
Vallés J., Fernández I., Alcaraz D., Chacón E., Cazorla A., Canals M., Mariscal D., Fontanals D., Morón A.
Objectives: Povidone-iodine is the most common catheter-site disinfectant, but accumulating evidence has indicated that chlorhexidine gluconate may be a more effective agent. On the other hand, 2% aquous clorhexidine gluconate is not available in our country.
The aim of this study was to compare the effectiveness in preventing central venous and arterial catheter colonisation of three protocols of skin antisepsis using 10% aqueous povidone-iodine (PI), 2% aqueous chlorhexidine gluconate (AC), and 0.5% alcoholic chlorhexidine gluconate (ALC) solutions.
Methods: Prospective and randomised trial in a medical-surgical intensive care unit (ICU) in a teaching hospital. All patients admitted to the ICU and requiring the insertion of a central venous and/or arterial catheter from January 1, 2005 to June 30, 2006 were included in the study. Patients were randomised assigned to each group according to the antiseptic solution used for insertion the catheter. Catheter distal tips were quantitatively cultured when catheters were no longer necessary and if there was a suspicion of catheter-related infection. Rates of catheter colonisation and catheter-related bacteraemia were compared in the three groups.
Results: A total of 631 catheters were included in the study (194 in PI group, 211 in AC group, and 226 in ALC group). The incidence of catheter colonisation was significantly lower in the ALC and AC groups than in PI group (14.2% vs 24.7% [RR 0.5, 95% CI 0.3 to 0.8, p < 0.01] and 16.1% vs 24.7% [RR 0.6, 95% CI 0.4 to 0.9, p:0.03], respectively). The incidence-rate per 1,000 catheter-days were also significantly lower in the ALC and AC groups than PI group (19.8 vs 31.8; p:0.02 and 21.8 vs 31.8; p:0.02, respectively). There were not difference among ALC and AC groups. Catheter-related bacteraemia were similar in the three groups. Both types of chlorhexidine solutions were superior to povidone-iodine solution in preventing catheter colonisations due to Gram-positive bacteria (p:0.03), whereas there were not difference in preventing Gram-negative bacteria colonisation.
Conclusions: We conclude that use of both ALC and AC solutions for disinfection of intravascular catheter sites reduces the incidence of catheter colonisation compared with 10% aqueous PI solution in an adult ICU. This effect seems to be related to the more efficacious prevention of colonisation with Gram-positive bacteria.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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