Study Recommends Chlorhexidine for CVC Site Care
Chlorhexidine gluconate used for central venous catheter (CVC) site cleansing can reduce the risk of bloodstream infections by 49% compared with povidone-iodine, according to the results of a meta-analysis reported in the June 4 issue of the Annals of Internal Medicine [Ann Intern Med. 2002;136(11):792-801.]
Eight in-hospital, randomized control studies involving a total of 4143 catheters of various types were included in the analysis. Most of the catheters (36%) were central venous catheters. In patients whose catheter sites were disinfected with chlorhexidine gluconate, about 1% developed bloodstream infections, as opposed to 2% for those whose catheters were disinfected with povidone-iodine.
From this data the authors conclude that chlorhexidine gluconate solution is significantly more effective than povidone-iodine solution for preventing vascular catheter-related infections. They estimate that for every 1000 catheter sites disinfected with chlorhexidine gluconate rather than povidone-iodine, 71 episodes of catheter colonization and 11 episodes of catheter-related blood stream infection (CRBSI) would be prevented.
Why Chlorhexidine May Be Better
The authors postulate that chlorhexidine gluconate may be superior for catheter site care for several reasons. First, blood, serum, and other protein-rich biomaterials can deactivate the microbicidal effect of povidone-iodine but not chlorhexidine gluconate. Second, chlorhexidine gluconate has a much longer active antimicrobial suppression than povidone-iodine. Third, chlorhexidine gluconate has been proven better than povidone-iodine at reducing colony counts of coagulase-negative staphylococci.
Readers should be cautioned against generalizing the results to their own experience, since the studies looked at in-hospital catheter use, and the catheter was in place only 1 to 10 days, on average.
Despite the limitations the implications of this research are substantial in reducing costly, life-threatening infections. Ironically, cost may be one reason why chlorhexidine gluconate is not more widely used; the author’s report chlorhexidine gluconate costs approximately $0.92 for a quantity sufficient to prepare an insertion site for a CVC, versus $0.41 for a similar quantity of povidone-iodine. They are hopeful that a cost-savings maybe found with further analysis that adjusts for the cost of treating a CRBSI.