Abstract
The most common treatment for skin antisepsis at the insertion site of central venous catheters in Japan is 10% povidone-iodine (PVP-I) solution. Recently, chlorhexidine gluconate (CHG) for skin antisepsis has been shown to be more effective than PVP-I solution in reducing the risk of bloodstream infections based on meta-analysis of clinical trials from overseas. Additionally, the CDC guidelines recommend 2% CHG antiseptic solution to prevent infections associated with central venous catheter insertion. We applied 10 w/v% PVP-I solution or 1 w/v% CHG-ethanol solution for skin antisepsis at the central venous catheter insertion site, and obtained surface cultures at each dressing change or on removal of the catheter. We then examined the incidence of bloodstream infections in 85 subjects (53 males and 32 females). Cultures from swab specimens were positive in 10 of 97 tests in the 1 w/v% CHG-ethanol group and 19 of 84 tests in the 10 w/v% PVP-I group. The positive culture rate was significantly lower in the 1 w/v% CHG-ethanol group than in the 10 w/v% PVP-I group (10.3% vs. 22.6%, P=0.024, RR=0.456, CI: 0.225-0.925). The incidence of bloodstream infections was 1 in 43 cases in the 1 w/v% CHG-ethanol group and 10 in 50 cases in the 10 w/v% PVP-I group. Therefore, 1 w/v% CHG-ethanol solution for skin antisepsis at the catheter insertion site reduces microbial colonization on the site surface and tends to reduce the risk of bloodstream infections.
