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Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients

Published online by Cambridge University Press:  02 January 2015

J. Vallés ,
I. Fernández ,
D. Alcaraz ,
E. Chacón ,
A. Cazorla ,
M. Canals ,
D. Mariscal ,
D. Fontanals  and
A. Morón
J. Vallés*
Affiliation:
Critical Care Center, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
I. Fernández
Affiliation:
Critical Care Center, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
D. Alcaraz
Affiliation:
Critical Care Center, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
E. Chacón
Affiliation:
Critical Care Center, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
A. Cazorla
Affiliation:
Critical Care Center, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
M. Canals
Affiliation:
Critical Care Center, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
D. Mariscal
Affiliation:
Microbiology Laboratory, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
D. Fontanals
Affiliation:
Microbiology Laboratory, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
A. Morón
Affiliation:
Pharmacy Department, Hospital Sabadell, Institut Universitari Pare Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain
*
Critical Care Center, Hospital Sabadell, Pare Tauli s/n, 08208 Sabadell, Spain ([email protected])
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Abstract

Objective.

To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).

Design.

Prospective, randomized controlled trial.

Setting.

Intensive care unit in a teaching hospital.

Methods.

Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.

Results.

A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1 % vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.

Conclusions.

The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 9 , September 2008 , pp. 847 - 853
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Raad, I. Intravascular-catheter-related infections. Lancet 1998;351:893–898.CrossRefGoogle ScholarPubMed
2.Smith, RL, Meixler, SM, Simberkoff, MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 1991;100:164–167.CrossRefGoogle ScholarPubMed
3.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.CrossRefGoogle ScholarPubMed
4.Vallés, J, León, C, Alvarez-Lerma, F; Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Espanola de Medicina Intensiva y Unidades Coronarias (SEMIUC). Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Clin Infect Dis 1997;24:387–395.CrossRefGoogle Scholar
5.Jarvis, WR, Edwards, J, Culver, DH, et al.Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(Suppl 3B):185S–191S.CrossRefGoogle ScholarPubMed
6.Renaud, B, Brun-Buisson, C; ICU-Bacteremia Study Group. Outcomes of primary and catheter.related bacteremia: a cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 2001;163:1584–1590.CrossRefGoogle ScholarPubMed
7.Blot, SI, Depuydt, P, Annemans, L, et al.Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005;41:1591–1598.CrossRefGoogle ScholarPubMed
8.Raad, I, Hohn, DC, Gillbreath, BJ, et al.Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994;15:231–238.CrossRefGoogle ScholarPubMed
9.Maki, DG, Ringer, M, Alvarado, CJ. Prospective, randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339–343.CrossRefGoogle ScholarPubMed
10.Mimoz, O, Pieroni, L, Lawrence, C, et al.Prospective, randomized trial of two antiseptic solutions for prevention of central venous and arterial catheter colonization and infection in intensive care patients. Crit Care Med 1996;24:1818–1823.CrossRefGoogle Scholar
11.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
12.O'Grady, NP, Alexander, M, Patchen Dellinger, E, et al.Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2002;35:1281–1307.CrossRefGoogle Scholar
13.Parienti, JJ, du Chevron, D, Ramakers, M, et al.Alcoholic povidone-iodine to prevent central venous catheter colonization: a randomized unit-crossover study. Crit Care Med 2004;32:708–713.CrossRefGoogle ScholarPubMed
14.Mimoz, O, Villeminey, S, Ragot, S, et al.Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med 2007;167:2066–2072.CrossRefGoogle ScholarPubMed
15.Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous catheter related infection. N Engl J Med 1977;296:1305–1309.CrossRefGoogle ScholarPubMed
16.Murray, PR, Baron, EJ, Jorgensen, JH, Phaller, MA, Yolken, RH, eds. Manual of Clinical Microbiology. 8th ed. Washington, DC: ASM Press; 2003.Google Scholar
17.Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 14th and 16th informational supplements. CLSI document. Wayne, PA: CLSI, 2005 and 2006:M100-S15/S16.Google Scholar
18.Safdar, N, Maki, DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30:62–67.CrossRefGoogle ScholarPubMed
19.Humar, A, Ostromecki, A, Direnfeld, J, et al.Prospective ranzomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection. Clin Infect Dis 2000;31:1001–1007.CrossRefGoogle Scholar
20.Shelton, DM. A comparison of the effects of two antiseptic agents on Staphylococcus epidermidis colony forming units at the peritoneal dialysis catheter exit site. Adv Perit Dial 1991;7:120–124.Google ScholarPubMed
21.Rijnders, BJA, Van Wijngaerden, E, Peetermans, WE. Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? Clin Infect Dis 2002;35:1053–1058.CrossRefGoogle ScholarPubMed