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Olivier Mimoz, MD, PhD; Stéphanie Villeminey, MD; Stéphanie Ragot, PharmD, PhD; Claire Dahyot-Fizelier, MD; Leila Laksiri, MD; Franck Petitpas, MD; Bertrand Debaene, MD, PhD

Arch Intern Med. 2007;167(19):2066-2072.

Background  Although chlorhexidine-based solutions and alcohol-based povidone-iodine have been shown to be more efficient than aqueous povidone-iodine for skin disinfection at catheter insertion sites, their abilities to reduce catheter-related infection have never been compared.

Methods  Consecutively scheduled central venous catheters inserted into jugular or subclavian veins were randomly assigned to be disinfected with 5% povidone-iodine in 70% ethanol or with a combination of 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzylic alcohol. Solutions were used for skin disinfection before catheter insertion (2 consecutive 30-second applications separated by a period sufficiently long to allow for dryness) and then as single applications during subsequent dressing changes (every 72 hours, or earlier if soiled or wet).

Results  Of 538 catheters randomized, 481 (89.4%) produced evaluable culture results. Compared with povidone-iodine, the chlorhexidine-based solution was associated with a 50% decrease in the incidence of catheter colonization (11.6% vs 22.2% [P = .002]; incidence density, 9.7 vs 18.3 per 1000 catheter-days) and with a trend toward lower rates of catheter-related bloodstream infection (1.7% vs 4.2% [P = .09]; incidence density, 1.4 vs 3.4 per 1000 catheter-days). Independent risk factors for catheter colonization were catheter insertion into the jugular vein (adjusted relative risk, 2.01; 95% confidence interval, 1.24-3.24) and use of povidone-iodine (adjusted relative risk, 1.87; 95% confidence interval, 1.18-2.96). 

Conclusion  Chlorhexidine-based solutions should be considered as a replacement for povidone-iodine (including alcohol-based) formulations in efforts to prevent catheter-related infection.

Trial Registration  clinicaltrials.gov Identifier: NCT00259350

Author Affiliations: Département d’Anesthésie Réanimation, Centre Hospitalier et Universitaire de Poitiers (Drs Mimoz, Villeminey, Ragot, Dahyot-Fizelier, Laksiri, Petitpas, and Debaene), Université de Poitiers (Drs Mimoz, Ragot, Dahyot-Fizelier, Laksiri, Petitpas, and Debaene), and Institut National de la Santé et de la Recherche Médicale, ERI 23 (Drs Mimoz, Dahyot-Fizelier, and Laksiri), Poitiers, France.

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