Antiseptics To Prevent Infection from Intravascular Catheters

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The summary below is from the full report titled "Chlorhexidine Compared with Povidone-Iodine Solution for Vascular Catheter-Site Care: A Meta-Analysis." It appears in the 4 June 2002 issue of Annals of Internal Medicine (volume 136, pages 792-801). The authors are N Chaiyakunapruk, DL Veenstra, BA Lipsky, and S Saint.

What is the problem and what is known about it so far?

Catheters are small, flexible plastic tubes. They are commonly inserted into veins or arteries (intravascularly) to deliver fluid or drugs directly into the bloodstream or to help perform special tests. Intravascular catheters are normally inserted through the skin. The skin's surface has bacteria that can cause infection. Antiseptic preparations are used to clean the skin around the area where catheters are inserted. These preparations contain chemicals that kill or prevent growth of bacteria. The main aims of antiseptic use are to "disinfect skin" and to stop bacteria from entering the bloodstream and causing serious infection. There are many kinds of antiseptics. Two types that are used in many hospitals are chlorhexidine gluconate and povidone-iodine. Several studies have compared the ability of these two preparations to prevent serious infection from occurring with intravascular catheter use.

Why did the researchers do this particular study?

To find out which of two antiseptic preparations, chlorhexidine gluconate or povidone-iodine, is better at preventing infection in persons with intravascular catheters.

Who was studied?

Rather than perform another study themselves, the researchers used information from eight previously published studies that compared the two preparations. All of the patients in the studies were hospitalized adults. Five studies included only patients from intensive care units.

How was the study done?

The eight studies were all randomized trials that directly compared chlorhexidine gluconate with povidone-iodine for catheter-site care. The studies involved 4143 intravascular catheters. The researchers reviewed the studies to determine the number of bloodstream infections that occurred in patients who had had their skin disinfected with either preparation. They combined the results from all of the studies using a special analysis method (meta-analysis).

What did the researchers find?

Chlorhexidine gluconate cut the rate of bloodstream infections in half compared with povidone-iodine (about 1% vs. about 2%).

What were the limitations of the study?

Different types of chlorhexidine gluconate preparations were used in the studies. We cannot tell whether one type is better than another. The eight trials used different definitions of bloodstream infections. Some definitions were less precise than others.

What are the implications of the study?

Compared with povidone-iodine, chlorhexidine gluconate solution reduces the risk for intravascular catheter–related bloodstream infections in hospitalized patients by about 50% (from about 2% to about 1%).