Lai, N.M., Lai, N.A., O'Riordan, E., Chaiyakunapruk, N., Taylor, J.E., & Tan, K. (2016). Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database of Systematic Reviews, 7, CD010140.

DOI Link

Purpose

STUDY PURPOSE: To evaluate skin antisepsis in reducing catheter-related bloodstream infections (BSIs), catheter colonization, morbidities, and mortality

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Cochrane Collaboration, MEDLINE, EMBASE, CINAHL, and clinical trial registries
 
INCLUSION CRITERIA: Randomized, controlled trials comparing skin antiseptic regimens with another regimen, placebo, or no antisepsis
 
EXCLUSION CRITERIA: Crossover studies, studies involving catheters for hemodialysis

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 574
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Risk of Bias Tool and GRADE categorization. Most studies were deemed to be of low or very low quality.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 12 studies included in meta-analysis 
  • TOTAL PATIENTS INCLUDED IN REVIEW: 2,011
  • SAMPLE RANGE ACROSS STUDIES: 50–420
  • KEY SAMPLE CHARACTERISTICS: Included studies in pediatric patients. Most studies included patients in intensive care units.

Phase of Care and Clinical Applications

PHASE OF CARE: Not specified or not applicable

Results

Analysis of chlorhexidine versus povidone iodine showed a relative risk of 0.064 (p = 0.05) in favor of chlorhexidine for the outcome of BSI. No significant difference existed between these two methods for all-cause mortality. Chlorhexidine was associated with less catheter colonization (RR = –0.08, p = 0.0003). Few studies compared the use of alcohol, octenidine, hydrogen peroxide, and silver.

Conclusions

The findings suggest that skin antisepsis with chlorhexidine is most effective in reducing BSI; however, the overall quality of the evidence is very low to moderate.

Limitations

Mostly low quality/high risk of bias studies

Nursing Implications

Chlorhexidine is generally more effective than povidone iodine or alcohol for skin antisepsis as part of catheter care for reducing catheter-related BSIs and catheter colonization.

Legacy ID

6431