Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T04:05:08.021Z Has data issue: false hasContentIssue false
  • English
  • Français

Blood Culture Contamination Rates after Skin Antisepsis with Chlorhexidine Gluconate versus Povidone-Iodine in a Pediatric Emergency Department

Published online by Cambridge University Press:  02 January 2015

Lauren Marlowe ,
Rakesh D. Mistry ,
Susan Coffin ,
Kateri H. Leckerman ,
Karin L. McGowan ,
Dingwei Dai ,
Louis M. Bell  and
Theoklis Zaoutis
Lauren Marlowe
Affiliation:
Divisions of General Pediatrics, Philadelphia, Pennsylvania University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Rakesh D. Mistry
Affiliation:
Emergency Medicine, Philadelphia, Pennsylvania Children's Hospital of Philadelphia, and the Department of Pediatrics, Philadelphia, Pennsylvania
Susan Coffin
Affiliation:
Infectious Diseases, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, Philadelphia, Pennsylvania Children's Hospital of Philadelphia, and the Department of Pediatrics, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania
Kateri H. Leckerman
Affiliation:
Infectious Diseases, Philadelphia, Pennsylvania Department of Pathology and Laboratory Medicine, Philadelphia, Pennsylvania
Karin L. McGowan
Affiliation:
Department of Pathology and Laboratory Medicine, Philadelphia, Pennsylvania
Dingwei Dai
Affiliation:
Center for Pediatric Clinical Effectiveness, Philadelphia, Pennsylvania
Louis M. Bell
Affiliation:
Divisions of General Pediatrics, Philadelphia, Pennsylvania Infectious Diseases, Philadelphia, Pennsylvania Children's Hospital of Philadelphia, and the Department of Pediatrics, Philadelphia, Pennsylvania
Theoklis Zaoutis*
Affiliation:
Infectious Diseases, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, Philadelphia, Pennsylvania Children's Hospital of Philadelphia, and the Department of Pediatrics, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania
*
Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, CHOP North, Room 1527, Philadelphia, PA 19104, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Objective.

To determine blood culture contamination rates after skin antisepsis with Chlorhexidine, compared with povidone-iodine.

Design.

Retrospective, quasi-experimental study.

Setting.

Emergency department of a tertiary care children's hospital.

Patients.

Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008. Control patients were children younger than 2 months with peripheral blood culture results.

Methods.

Blood culture contamination rates were compared using segmented regression analysis of time-series data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 2-36 months during the 26-month postintervention period, in which 3% Chlorhexidine gluconate was used; and (3) patients younger than 2 months not exposed to the Chlorhexidine intervention (ie, the control group).

Results.

Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group, 4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months, the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures (P < .05) after implementation of Chlorhexidine. This decrease of 7.62 contaminated cultures per 1,000 cultures (95% confidence interval, —0.781 to —15.16) represented a 30% relative decrease from the preintervention period and was sustained over the entire postintervention period. No change in contamination rate was observed in the control group (P = .337).

Conclusion.

Skin antisepsis with Chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 2 , February 2010 , pp. 171 - 176
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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.Alpern, ER, Alessandrini, EA, Bell, LM, Shaw, KN, McGowan, KL. Occult bacteremia from a pediatric emergency department: current prevalence, time to detection, and outcome. Pediatrics 2000;106:505–511.CrossRefGoogle ScholarPubMed
2.Waddle, E, Jhaveri, R. Outcomes of febrile children without localising signs after pneumococcal conjugate vaccine. Arch Dis Child 2009;94:144–147.CrossRefGoogle ScholarPubMed
3.Stoll, ML, Rubin, LG. Incidence of occult bacteremia among highly febrile young children in the era of the pneumococcal conjugate vaccine: a study from a children's hospital emergency department and urgent care center. Arch Pediatr Adolesc Med 2004;158:671–675.CrossRefGoogle ScholarPubMed
4.Sard, B, Bailey, MC, Vinci, R. An analysis of pediatric blood cultures in the postpneumococcal conjugate vaccine era in a community hospital emergency department. Pediatr Emerg Care 2006;22:295–300.Google Scholar
5.Waltzman, ML, Harper, M. Financial and clinical impact of false-positive blood culture results. Clin Infect Dis 2001;33:296–299.CrossRefGoogle ScholarPubMed
6.Norberg, A, Christopher, NC, Ramundo, ML, Bower, JR, Berman, SA. Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter. JAMA 2003;289:726–729.CrossRefGoogle ScholarPubMed
7.Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA 1991;265:365–369.CrossRefGoogle ScholarPubMed
8.Thuler, LC, Jenicek, M, Turgeon, JP, Rivard, M, Lebel, P, Lebel, MH. Impact of a false positive blood culture result on the management of febrile children. Pediatr Infect Dis J 1997;16:846–851.CrossRefGoogle ScholarPubMed
9.Milstone, AM, Passaretti, CL, Perl, TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008;46:274–281.Google ScholarPubMed
10.Chaiyakunapruk, N, Veenstra, DL, Lipsky, BA, Saint, S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002;136:792–801.CrossRefGoogle ScholarPubMed
11.O'Grady, NP, Alexander, M, Dellinger, EP, et al; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Pediatrics 2002;110:e51.Google Scholar
12.Rosenberg, A, Alatary, SD, Peterson, AF. Safety and efficacy of the antiseptic Chlorhexidine gluconate. Surg Gynecol Obstet 1976;143:789–792.Google ScholarPubMed
13.Krautheim, AB, Jermann, TH, Bircher, AJ. Chlorhexidine anaphylaxis: case report and review of the literature. Contact Dermatitis 2004;50:113–116.CrossRefGoogle ScholarPubMed
14.Mimoz, O, Karim, A, Mercat, A, et al.Chlorhexidine compared with povidone-iodine as skin preparation before blood culture: a randomized, controlled trial. Ann Intern Med 1999;131:834–837.CrossRefGoogle ScholarPubMed
15.Suwanpimolkul, G, Pongkumpai, M, Suankratay, C. A randomized trial of 2% Chlorhexidine tincture compared with 10% aqueous povidone-iodine for venipuncture site disinfection: effects on blood culture contamination rates. J Infect 2008;56:354–359.Google Scholar
16.Madeo, M, Barlow, G. Reducing blood-culture contamination rates by the use of a 2% Chlorhexidine solution applicator in acute admission units. J Hosp Infect 2008;69:307–309.CrossRefGoogle ScholarPubMed
17.Mullany, LC, Darmstadt, GL, Tieisch, JM. Safety and impact of Chlorhexidine antisepsis interventions for improving neonatal health in developing countries. Pediatr Infect Dis J 2006;25:665–675.Google Scholar
18.Centers for Disease Control and Prevention. Device-associated module: central line-associated bloodstream infection (CLABSI) event. In The National Healthcare Safety Network (NHSN) Manual: Patient Safety Component Protocol. Atlanta, GA: Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, 2009. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed December 21, 2009.Google Scholar
19.Gillings, D, Makuc, D, Siegel, E. Analysis of interrupted time series mortality trends: an example to evaluate regionalized perinatal care. Am J Public Health 1981;71:38–46.CrossRefGoogle ScholarPubMed
20.Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27:299–309.CrossRefGoogle ScholarPubMed
21.Durbin, J, Watson, GS. Testing for serial correlation in least squares regression. I. Biometrika 1950;37:409–428.Google ScholarPubMed
22.Kleinbaum, D, Kupper, LL, Muller, KE. Applied Regression Analysis and Other Multivariable Methods. 2nd ed. Belmont, CA: Duxbury, 1988.Google Scholar
23.Lee, GM, Harper, MB. Risk of bacteremia for febrile young children in the post-Haemophilus influenzae type bera. Arch Pediatr Adolesc Med 1998;152:624–628.CrossRefGoogle Scholar
24.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;107:119–125.CrossRefGoogle ScholarPubMed
25.Strand, CL, Wajsbort, RR, Sturmann, K. Effect of iodophor vs iodine tincture skin preparation on blood culture contamination rate. JAMA 1993;269:1004–1006.CrossRefGoogle ScholarPubMed
26.Barenfanger, J, Drake, C, Lawhorn, J, Verhulst, SJ. Comparison of Chlorhexidine and tincture of iodine for skin antisepsis in preparation for blood sample collection. J Clin Microbiol 2004;42:2216–2217.Google Scholar
27.Trautner, BW, Clarridge, JE, Darouiche, RO. Skin antisepsis kits containing alcohol and Chlorhexidine gluconate or tincture of iodine are associated with low rates of blood culture contamination. Infect Control Hosp Epidemiol 2002;23:397–401.CrossRefGoogle ScholarPubMed
28.Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Per-encevich, EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004;38:1586–1591.Google Scholar
29.Ramsook, C, Childers, K, Cron, SG, Nirken, M. Comparison of blood-culture contamination rates in a pediatric emergency room: newly inserted intravenous catheters versus venipuncture. Infect Control Hosp Epidemiol 2000;21:649–651.CrossRefGoogle Scholar
30.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;35:563–565.Google Scholar
31.Weinstein, MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol 2003;41:2275–2278.CrossRefGoogle ScholarPubMed
32.Widmer, AF. Sterilization of skin and catheters before drawing blood cultures. J Clin Microbiol 2003;41:4910; author reply 4910.CrossRefGoogle ScholarPubMed