Chlorhexidine Compared with Povidone-Iodine Solution for Vascular Catheter–Site Care

Chlorhexidine Compared with Povidone-Iodine Solution for Vascular Catheter–Site Care

A Meta-Analysis

Nathorn Chaiyakunapruk, PharmD, PhD;
David L. Veenstra, PharmD, PhD;
Benjamin A. Lipsky, MD; and
Sanjay Saint, MD, MPH

From Naresuan University, Pitsanuloak, Thailand; University of Washington and Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; and University of Michigan and Ann Arbor Veterans Administration Medical Center, Ann Arbor, Michigan.

Abstract

Purpose: Bloodstream infections related to use of catheters, particularly central-line catheters, are an important cause of patient morbidity, mortality, and increased health care costs. This study evaluated the efficacy of skin disinfection with chlorhexidine gluconate compared with povidone-iodine solution in preventing catheter-related bloodstream infection.

Data Sources: Multiple computerized databases (1966 to 2001), reference lists of identified articles, and queries of principal investigators and antiseptic manufacturers.

Study Selection: Randomized, controlled trials comparing chlorhexidine gluconate with povidone-iodine solutions for catheter-site care.

Data Extraction: Using a standardized form, two reviewers abstracted data on study design, patient population, intervention, and incidence of catheter-related bloodstream infection from all included studies.

Data Synthesis: Eight studies involving a total of 4143 catheters met the inclusion criteria. All studies were conducted in a hospital setting, and various catheter types were used. The summary risk ratio for catheter-related bloodstream infection was 0.49 (95% CI, 0.28 to 0.88) in patients whose catheter sites were disinfected with chlorhexidine gluconate instead of povidone-iodine. Among patients with a central vascular catheter, chlorhexidine gluconate reduced the risk for catheter-related bloodstream infection by 49% (risk ratio, 0.51 [CI, 0.27 to 0.97]).

Conclusions: These results suggest that incidence of bloodstream infections is significantly reduced in patients with central vascular lines who receive chlorhexidine gluconate versus povidone-iodine for insertion-site skin disinfection. Use of chlorhexidine gluconate is a simple and effective means of reducing vascular catheter–related infections.

Article and Author Information

Acknowledgments: The authors thank Gerard Sheehan, MD, John M. Conly, MD, Raphaele Girard, MD, Angela LeBlanc, BSc (Hed), and Valerie Knasinski, RN, for providing citations of additional studies or additional information from their studies. They also thank Todd A. Lee, PharmD, PhD, for helping with the abstraction of these studies.
Requests for Single Reprints: David L. Veenstra, PharmD, PhD, Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, Box 357630, University of Washington, Seattle, WA 98195-7630; e-mail, veenstra{at}u.washington.edu.
Current Author Addresses: Dr. Chaiyakunapruk: Department of Pharmacy Practice, School of Pharmacy, Naresuan University, Pitsanuloak 65000, Thailand.
Dr. Veenstra: Pharmaceutical Outcomes Research and Policy Program, Box 357630, University of Washington, Seattle, WA 98195-7630.
Dr. Lipsky: Veterans Affairs Puget Sound Health Care System (S-111-GIMC), 1660 South Columbian Way, Seattle, WA 98108-1597.
Dr. Saint: University of Michigan Medical School, Room 7E08, 300 NIB, Campus Box 0429, Ann Arbor, MI 48109-0429.
Author Contributions: Conception and design: D.L. Veenstra, S. Saint.
Analysis and interpretation of the data: N. Chaiyakunapruk, D.L. Veenstra, B.A. Lipsky, S. Saint.
Drafting of the article: N. Chaiyakunapruk, B.A. Lipsky.
Critical revision of the article for important intellectual content: N. Chaiyakunapruk, D.L. Veenstra, B.A. Lipsky, S. Saint.
Final approval of the article: N. Chaiyakunapruk, D.L. Veenstra, B.A. Lipsky, S. Saint.
Statistical expertise: N. Chaiyakunapruk, D.L. Veenstra.
Obtaining of funding: D.L. Veenstra, S. Saint.
Administrative, technical, or logistic support: N. Chaiyakunapruk.
Collection and assembly of data: N. Chaiyakunapruk.