Intensive Care Medicine

, Volume 30, Issue 6, pp 1081–1088 | Cite as

Combined skin disinfection with chlorhexidine/propanol and aqueous povidone-iodine reduces bacterial colonisation of central venous catheters

  • Julia Langgartner
  • Hans-Jörg Linde
  • Norbert Lehn
  • Michael Reng
  • Jürgen Schölmerich
  • Thomas Glück
Original

Abstract

Objective

Central venous catheter (CVC)-related infections may be caused by micro-organisms introduced from the skin surface into deeper tissue at the time of CVC insertion. The optimal disinfection regimen to avoid catheter-related infections has not yet been defined. This study compares three different approaches.

Design

Prospective randomised trial.

Setting

A tertiary care hospital.

Patients and participants

One hundred nineteen patients scheduled electively to receive 140 CVCs.

Interventions

Skin disinfection was performed with either povidone-iodine 10% (PVP-iodine), chlorhexidine 0.5%/propanol 70%, or chlorhexidine 0.5%/propanol 70% followed by PVP-iodine 10%. Prior to disinfection, a swab from the site of insertion was taken for culture. CVCs were removed if no longer needed or infection was suspected. All catheters were cultured quantitatively after removal.

Measurement and results

Bacteria could be isolated from 20.7% of the catheter tips. Bacterial growth was found in 30.8% of the catheters placed after skin disinfection with povidone-iodine, in 24.4% after disinfection with propanol/chlorhexidine and in 4.7% after disinfection with propanol/chlorhexidine followed by povidone-iodine (p=0.006). In 15 cases, the same organism was isolated from the skin swab and the catheter tip. Ten of these paired isolates showed the same pattern in a pulsed-field gel electrophoresis analysis.

Conclusions

Skin disinfection with propanol/chlorhexidine followed by PVP-iodine was superior in the prevention of microbial CVC colonisation compared to either of the regimens alone. These results support the concept that catheter infections can originate from bacterial translocation at the time of catheter insertion.

Keywords

Skin disinfection Chlorhexidine Propanol Povidone-iodine Central venous catheter Infection Bacterial colonisation 

References

  1. 1.
    Pearson ML (1996) Guidelines for prevention of intravascular device-related infections. Part I: Intravascular device-related infections: an overview. Infection control Practices Advisory committee. Am J Infect Control 24:262–277PubMedGoogle Scholar
  2. 2.
    Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Guidelines for prevention of intravascular catheter-related infections. Healthcare infection control practices advisory committee. MMWR 51/RR-10:1–32Google Scholar
  3. 3.
    Maki DG, Stolz SM, Wheeler S, Mermel LA (1997) Prevention of central venous catheter related infections by use of an antiseptic impregnated catheter. A randomized controlled study. Ann Intern Med 127:257–266PubMedGoogle Scholar
  4. 4.
    Raad I, Darouiche R, Dupuis J, Abi-Said D, Gabrielli A, Hachem R, Wall M, Harris R, Jones J, Buzaid A, Robertson C, Shenaq S, Curling P, Burke T, Ericsson C (1997) Central venous catheters coated with minocyclin and rifampin for the prevention of catheter-related colonization and bloodstream infections: a randomized double-blind trial. Ann Intern Med 127:267–274Google Scholar
  5. 5.
    Arnow PM, Quimosing EM, Brech M (1993) Consequences of intravascular catheter sepsis. Clin Infect Dis 16:778–784PubMedGoogle Scholar
  6. 6.
    Pittet D, Tarara D, Wenzel RP (1994) Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs and attributable mortality. JAMA 271:1598–1601PubMedGoogle Scholar
  7. 7.
    Smith RL. Meixler SM, Simberkoff MS (1991) Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 100:164–167PubMedGoogle Scholar
  8. 8.
    Renaud B, Brun-Buisson C, for the ICU-Bacteremia Study Group (2001) Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 163:1584–1590Google Scholar
  9. 9.
    Rello J, Ochagavia A, Sabanes E, Roque M, Mariscal D, Reynaga E, Valles J (2000) Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am J Respir Crit Care Med 162:1027–1030Google Scholar
  10. 10.
    Pearson ML (1996) Guidelines for prevention of intravascular device-related infections. Part II: Recommendations for the prevention of nosocomial intravascular device-related infections. Infection control practices advisory committee. Am J Infect Control 24:277–293PubMedGoogle Scholar
  11. 11.
    Lacour M, Gastmeier P, Rüden H, Daschner F (1998) Prävention von Infektionen durch intravasale Katheter. Intensivmed 35:585–592Google Scholar
  12. 12.
    Safdar N, Kluger DM, Maki DG (2002) A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore) 81:466–479Google Scholar
  13. 13.
    Elliott TSJ, Moss HA, Tebbs SE, Wilson IC, Bonser RS, Graham TR, Burke LP, Faroqui MH (1997) Novel approach to investigate a source of microbial contamination of central venous catheters. Eur J Clin Microbiol Infect Dis 16:210–213PubMedGoogle Scholar
  14. 14.
    Livesley MA, Tebbs SE, Moss HA, Faroqui MH, Lambert PA, Elliott TSJ (1998) Use of pulse field gel electrophoresis to determine the source of microbial contamination of central venous catheters. Eur J Clin Microbiol Infect Dis 17:108–112CrossRefPubMedGoogle Scholar
  15. 15.
    Maki DG, Ringer M, Alvarado CJ (1991) Prospective randomised trial of povodine-iodine, alcohol and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 338:339–343CrossRefPubMedGoogle Scholar
  16. 16.
    Mimoz O, Pieroni L, Lawrence C, Edouard A, Costa Y, Samii K, Brun-Buisson C (1996) Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med 24:1818–1823CrossRefPubMedGoogle Scholar
  17. 17.
    Maki DG, Weise CE, Sarafin HW (1977) A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 296:1305–1309PubMedGoogle Scholar
  18. 18.
    Tenover F, Arbeit RD, Goering PA, Mickelsen PA, Murray BE, Persing DH, Swaminathan B (1995) Interpreting chromosomal DANN restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial stain typing. J Clin Microbiol 33:2233–2239PubMedGoogle Scholar
  19. 19.
    Gautom RK (1997) Rapid pulsed-field gel electrophoresis protocol for typing of Escherichia coli O157:H7 and other gram-negative organisms in 1 day. J Clin Microbiol 35:2977–2980PubMedGoogle Scholar
  20. 20.
    Morrison D, Woodford N, Barrett SP, Sisson P, Cookson BD (1999) DNA banding pattern polymorphism in vancomycin-resistant Enterococcus faecium and criteria for defining strains. J Clin Microbiol 37:1084–1091PubMedGoogle Scholar
  21. 21.
    Turabelidze D, Kotetishvili M, Kreger J, Morris G, Sulakvelidze (2000) Improved pulsed-field gel electrophoresis for typing vancomycin-resistant enterococci. J Clin Microbiol 38:4242–4245PubMedGoogle Scholar
  22. 22.
    Sloos JH, Dijkshoorn L, Vogel L, van Boven CP (2000) Performance of phenotypic and genotypic methods to determine the clinical relevance of serial blood isolates of Staphylococcus epidermidis in patients with septicemia. J Clin Microbiol 38:2488–2493PubMedGoogle Scholar
  23. 23.
    Garland JS, Buck RK, Maloney P, Durkin DM, Toth-Lloyd S, Duffy M, Szocik P, McAuliffe TL, Goldmann D (1995) Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J 14:510–516PubMedGoogle Scholar
  24. 24.
    Humar A, Ostromecki A, Direnfeld J, Marshall JC, Lazar N, Houston PC, Boiteau P, Conly JM (2000) Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection. Clin Inf Dis 31:1001–1007CrossRefGoogle Scholar
  25. 25.
    Mimoz O, Karim A, Mercat A, Cosseron M, Falissard B, Parker F, Richard C, Samii K, Nordmann P (1999) Chlorhexidine compared with povidone-iodine as skin preparation before blood culture. A randomized controlled trial. Ann Intern Med 121:834–837Google Scholar
  26. 26.
    Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S (2002) Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 136:792–801PubMedGoogle Scholar
  27. 27.
    Goldblum SE, Ulrich JA, Goldman RS, Reed WP, Avasthi PS (1983) Comparison of 4% chlorhexidine gluconate in a detergent base (Hibiclens) and povidone-iodine (Betadine) for the skin preparation of hemodialysis patients and personnel. Am J Kidney Dis 2:548–552PubMedGoogle Scholar
  28. 28.
    May SR, Roberts DP, DeClement FA, Still JM (1991) Reduced bacteria on transplantable allograft skin after preparation with chlorhexidine gluconate, povidone-iodine and isopropanol. J Burn Care Rehabil 12:224–228PubMedGoogle Scholar
  29. 29.
    Corona ML, Peters SG, Narr BJ, Thompson RL (1190) Infections related to central venous catheters. Mayo Clin Proc 65:979–986Google Scholar
  30. 30.
    Linares J, Dominguez MA, Martin R (1997) Current laboratory techniques in the diagnosis of catheter-related infections. Nutrition 13:10S–14SPubMedGoogle Scholar
  31. 31.
    Gebler H (1998) Tabellen für die pharmazeutische Praxis. Govi, Eschborn p 426Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Julia Langgartner
    • 1
  • Hans-Jörg Linde
    • 2
  • Norbert Lehn
    • 2
  • Michael Reng
    • 1
  • Jürgen Schölmerich
    • 1
  • Thomas Glück
    • 1
  1. 1.Department of Internal Medicine I, University Medical CentreUniversity of RegensburgRegensburgGermany
  2. 2.Institute of Medical Microbiology and Hygiene, University Medical CentreUniversity of RegensburgRegensburgGermany

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