Enturia

18. Prevention of Infections Related to Central Venous Catheters and Arterial Catheters in Intensive Care Patients

Kelly JW, Usry G, Blackhurst D, Bushey M, Steed C. Prevention of infections related to central venous catheters and arterial catheters in intensive care patients: a prospective randomized trial of chlorhexidine gluconate (CHG) versus povidone iodine (PI). Presented at: 15th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 9–12, 2005; Los Angeles, Calif. Abstract 165.

Rationale
Skin disinfection is of primary importance in preventing intravascular device infections. ChloraPrep (2% chlorhexidine gluconate [CHG] in 70% isopropyl alcohol [IPA]) has been recommended over 10% povidone iodine (PVI) solution as the agent of choice in skin disinfection for intravenous (IV) catheter insertions.

Objective
To compare the effectiveness of ChloraPrep versus 10% PVI in reducing the risk of catheter-related infections.

Design
A prospective randomized trial of ChloraPrep versus PVI conducted in an urban hospital system setting.

Methods

• Patients were randomized to receive either ChloraPrep or PVI for skin antisepsis and site care
• Catheters were changed and cultures obtained as clinically indicated by the intensive care unit team
• Patients were assessed every 48 hours for the presence of exit site infection, catheter-related infection, and catheter-related bacteremia

End Points

• The primary end points were crude rates of catheter-related infections and primary bloodstream infections 48 hours after catheter insertion for ChloraPrep versus PVI
• The secondary end points were rates of catheter-related infections and primary bloodstream infections per 1000 days of catheter insertion for ChloraPrep versus PVI

Results

• Patient characteristics
  • A total of 164 patients were enrolled
  • Patients were randomized to receive either ChloraPrep (n=82) or PVI (n=82)
  • Study groups were comparable for all important patient characteristics
  • Rates of local site infections were not significantly different between groups
• Crude rates of catheter-related infections and primary bloodstream infections were significantly lower in the ChloraPrep group than in the PVI group
  • Catheter-related infections: 4.9% versus 18.3%, respectively
  • Primary bloodstream infections: 1.2% versus 9.8%, respectively
• Rates of catheter-related infections and primary bloodstream infections per 1,000 days of catheter insertion were lower in the ChloraPrep group than in the PVI group
  • Catheter-related infections: 5.1 days versus 14.5 days, respectively
  • Primary bloodstream infections: 1.3 days versus 7.7 days, respectively
• Adjusted relative risk of catheter-related bacteremia was 0.27 for the ChloraPrep group
• Economic analysis showed a cost savings of $850 to $1,202 per patient in the ChloraPrep group

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