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Comparison of alcoholic chlorhexidine and povidone–iodine cutaneous antiseptics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study

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Abstract

Purpose

Compare the effectiveness of different cutaneous antiseptics in reducing risk of catheter-related infection in intensive care unit (ICU) patients.

Methods

We compared the risk of central venous catheter-related infection according to four-step (scrub, rinse, dry, and disinfect) alcoholic 5 % povidone–iodine (PVI-a, n = 1521), one-step (disinfect) alcoholic 2 % chlorhexidine (2 % CHX-a, n = 1116), four-step alcoholic <1 % chlorhexidine (<1 % CHX-a, n = 357), and four-step aqueous 10 % povidone–iodine (PVI, n = 368) antiseptics used for cutaneous disinfection and catheter care during the 3SITES multicenter randomized controlled trial. Within this cohort, we performed a quasi-experimental study (i.e., before–after) involving the four ICUs which switched from PVI-a to 2 % CHX-a. We used propensity score matching (PSM, n = 776) and inverse probability weighting treatment (IPWT, n = 1592). The end point was the incidence of catheter-related infection (CRI) defined as catheter-related bloodstream infection (CRBSI) or a positive catheter tip culture plus clinical sepsis on catheter removal.

Results

In the cohort analysis and compared with PVI-a, the incidence of CRI was lower with 2 % CHX-a [adjusted hazard ratio (aHR), 0.51; 95 % confidence interval (CI) (0.28–0.96), p = 0.037] and similar with <1 % CHX-a [aHR, 0.73; (0.36–1.48), p = 0.37] and PVI [aHR, 1.50; 95 % CI (0.85–2.64), p = 0.16] after controlling for potential confounders. In the quasi-experimental study and compared with PVI-a, the incidence of catheter-related infection was again lower with 2 % CHX-a after PSM [HR, 0.35; 95 % CI (0.15, 0.84), p = 0.02] and in the IPWT analysis [HR, 0.31; 95 % CI (0.14, 0.70), p = 0.005]. The incidence of CRBSI or adverse event was not significantly different between antiseptics in all analyses.

Conclusions

In comparison with PVI-a, the use of 2 % CHX-a for cutaneous disinfection of the central venous catheter insertion site and maintenance catheter care was associated with a reduced risk of catheter infection, while the benefit of <1 % CHX-a was uncertain.

Clinical trials identifier: NCT01479153.

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Acknowledgments

We thank the nurses, infecton control teams, clinical research assistants and physicians in the participating centers. We also thank Cynthia T. Crosby from the Department of Clinical Research, CareFusion (BD), San Diego for providing alcoholic chlorhexidine at no cost.

Author information

Authors and Affiliations

  1. Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France

    Justine Pages, Jean-Jacques Dutheil, François Fournel & Jean-Jacques Parienti

  2. Department of Intensive Care Medicine, General Hospital, Saint Lô, France

    Pascal Hazera

  3. Department of Medial and Toxicologic Intensive Care, Lariboisière University Hospital, Paris, France

    Bruno Mégarbane

  4. Department of Intensive Care Medicine, Caen University Hospital, Caen, France

    Damien du Cheyron, Xavier Valette & Cédric Daubin

  5. EA4655 Risque Microbiens, Caen Normandie Université, Caen, France

    Damien du Cheyron & Jean-Jacques Parienti

  6. Department of Intensive Care Medicine, General Hospital, Pontoise, France

    Marie Thuong

  7. Warren Alpert Medical School of Brown University, Providence, RI, USA

    Leonard A. Mermel

  8. Department of Medial Intensive Care, Cochin University Hospital, Paris, France

    Jean-Paul Mira

  9. Department of Infectious Diseases, Caen University Hospital, Caen, France

    Jean-Jacques Parienti

Authors
  1. Justine Pages
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  2. Pascal Hazera
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  3. Bruno Mégarbane
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  6. Jean-Jacques Dutheil
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  8. François Fournel
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  9. Leonard A. Mermel
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  12. Jean-Jacques Parienti
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Consortia

3SITES Study Group

Corresponding author

Correspondence to Jean-Jacques Parienti.

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Conflicts of interest

JJP received research grants through his institution and personal fees from CareFusion. LAM received research grant support and personal fees from Marvao Medical and CareFusion, personal fees from Bard, 3M, and Fresenius. All other authors have no competing interests.

Additional information

Take-home message: Central venous catheter insertion site cutaneous antisepsis using one-step alcoholic 2 % chlorhexidine led to a greater reduction in catheter-related infection than four-step alcoholic 5 % povidone–iodine in ICU patients. Catheter-related bloodstream infection was not significantly different between antiseptics.

The members of the 3SITES Study Group are listed in the ESM.

Electronic supplementary material

Below is the link to the electronic supplementary material. Financial support: The 3SITES study was funded by the National Program for Clinical Research (PHRC-N 2010, 06-03) from the French Ministry of Health.

Supplementary material 1 (DOCX 279 kb)

Supplementary material 2 (DOCX 20 kb)

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Pages, J., Hazera, P., Mégarbane, B. et al. Comparison of alcoholic chlorhexidine and povidone–iodine cutaneous antiseptics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study. Intensive Care Med 42, 1418–1426 (2016). https://doi.org/10.1007/s00134-016-4406-4

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  • DOI: https://doi.org/10.1007/s00134-016-4406-4

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