Abstract & Commentary
Synopsis: An analysis of randomized trials of chlorhexidine vs. povidone-iodine preparation of catheter insertion sites shows a 50% relative reduction in catheter-related bacteremia with use of chlorhexidine.
Source: Chaiyakunapruk N, et al. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: A meta analysis. Ann Intern Med. 2002;136:792-801.
Chaiyakunapruk and colleagues performed a meta-analysis of randomized trials comparing chlorhexidine and povidone-iodine solution as skin disinfectants prior to insertion of vascular catheters. The primary end point was catheter-related blood stream infection (BSI); the secondary end point was catheter colonization. All studies defined catheter-related BSI as isolation of the same organism from blood and either semi-quantitative or quantitative catheter culture. They included 8 studies in the analysis, representing 4134 catheters. Multiple catheter types were represented including central venous (1493), peripheral venous (1361), and peripheral arterial (704). The risk of catheter- related bacteremia was significantly lower among patients receiving chlorhexidine disinfection (summary risk ratio, 0.49; 95% confidence interval, 0.31-0.71). The absolute risk reduction for BSI was 1.1%. The overall risk reduction was approximately 50% in all subgroups studied, including central and noncentral catheters. Catheter colonization was also significantly reduced in the chlorhexidine group, with an absolute risk reduction of 7.1%.
Comment by Robert Muder, MD
This meta-analysis shows conclusively that use of chlorhexidine skin disinfection significantly reduces the risk of catheter-related bacteremia. Despite the fact that multiple different catheter types and chlorhexidine formulations were used in the different studies, the findings appear to be fairly robust. There was little difference in treatment effect among catheter types, and the test for heterogeneity of treatment effect was not statistically significant. The study is not applicable to either tunneled catheters or antimicrobial impregnated catheters; these have a lower infection rate than standard catheters, and a treatment effect of chlorhexidine can’t be assumed.
The major disadvantage of chlorhexidine solutions is that they are approximately twice as expensive as povidone-iodine formation. Chaiyakunapruk et al estimate that the amount of chlorhexidine solution needed to disinfect skin adequately for catheter insertion is $0.92, compared with $0.41 for povidone iodine. Given the morbidity, potential mortality, and cost associated with catheter-related BSI, this cost difference is trivial. For example, the cost increase associated with chlorhexidine use that would result in the prevention of one BSI would be $510. A recent estimate of the cost of an episode of catheter-related BSI in an ICU setting was in excess of $50,000.1 Thus, use of chlorhexidine in preference to povidone-iodine is a simple, highly cost-effective means of reducing catheter-related BSI.
Dr. Muder, Hospital Epidemiologist, Pittsburgh VA Medical Center, Pittsburgh, is Associate Editor of Infectious Disease Alert.
Reference
1. Dimick JB, et al. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg. 2001;136:229-234.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content