Alcoholic povidone-iodine or chlorhexidine-based antiseptic for the prevention of central venous catheter-related infections: in-use comparison

Abstract

Purpose: To make a field comparison of the effectiveness, ease of use, and cost of a chlorhexidine antiseptic solution (CBA) and an alcohol-based povidone-iodine solution (PVP-IA) for the prevention of central venous catheter (CVC)-related infections in an intensive care unit, with the aim of identifying the superior antisepsis agent.

Materials and methods: We measured the CVC colonization and infection incidence for PVP-IA (Betadine alcoolique(®)) and for CBA (Biseptine(®)) during two successive 1-year periods of routine surveillance (REA RAISIN network). A questionnaire on the ease of CBA use was administered. Consumption data were obtained from the hospital pharmacy.

Results: The study included 806 CVC (CBA period: 371). Upon switching from PVP-IA to CBA, we recorded a significant reduction in colonization incidence/100 catheter days (1.12 vs. 1.55, p=0.041), nonsignificant differences concerning CVC-related infection incidence/100 catheter days (0.28 vs. 0.26, p=0.426), and a nonsignificant reduction in CVC-related bacteremia/100 catheter days (0.14 vs. 0.30, p=0.052). PVP-IA users were at significantly higher risk of CVC colonization or infection based on a multivariate Cox model analysis (relative risk [95% CI]: 1.48 [1.01-2.15], p=0.043). The main drawbacks of CBA use were its low cleansing activity and its colorless solution. No cost advantage was found.

Conclusions: Our field study revealed no major clinical advantage of CBA use in CVC infection and no cost advantage in addition to limited ease of use.