Yamamoto, N., Kimura, H., Misao, H., Matsumoto, H., Imafuku, Y., Watanabe, A., . . . Kanemitsu, K. (2014). Efficacy of 1.0% chlorhexidine-gluconate ethanol compared with 10% povidone-iodine for long-term central venous catheter care in hematology departments: A prospective study. American Journal of Infection Control, 42, 574–576. 

DOI Link

Study Purpose

To evaluate the effectivness of 1% chlorhexidine-gluconate ethanol (CHG-EtOH) versus 10% povidone-iodine among patients with hematologic malignancies and central line catheters

Intervention Characteristics/Basic Study Process

A randomized, controlled, prospective study was done among patients with hematologic maligancies and central venous catheters (CVCs). One group was assigned to clean the catheter site with 1% CHG-EtOH, and the other group used 10% povidone-iodine. All patients had weekly dressing changes with transparent, sterile dressings.
Patients were prepared for the insertion of CVCs with CHG-EtOH and povidone-iodine. Swab samples were taken for both groups before changing the CVC dressing weekly. Monitored patients who were febrile at 38°C and above or had infection, inflammation was observed at the CVC insertion site and blood cultures were taken within three hours of the incident. 

Sample Characteristics

  • N = 94 patients (107 CVCs)
  • MEAN AGE = 54.9 years (range = 17–86 years)
  • MALES: 42%, FEMALES: 58%
  • KEY DISEASE CHARACTERISTICS: Malignant lymphoma, acute myeloid leukemia, acute lymphoblastic leukemia, and multiple myeloma
  • OTHER KEY SAMPLE CHARACTERISTICS: Sites of CVCs were jugular, subclavian, and inguinal

Setting

  • SITE: Single site    
  • SETTING TYPE: Multiple settings    
  • LOCATION: Japan

Phase of Care and Clinical Applications

  • PHASE OF CARE: Transition phase after active treatment

Study Design

Randomized, controlled trial 

Measurement Instruments/Methods

  • Exit site infections and ​central line-associated bloodstream infections (CLABSIs) were measured as defined by the Centers for Disease Control and Prevention.

Results

CVC exit site colonization rates were 11.9% with chlorhexidine and 29.2% with povidone-iodine (p = 0.03). CLABSI rates were 3.4% with chlorhexidine and 14.6% with povidone-iodine (p = 0.08). The incidence per catheter days was higher in the povidone iodine group (RR = 0.23, p = 0.041).

Conclusions

This study suggests that the use of 1% CHG-EtOH while preparing patients for the insertion of a central line and while dealing with central lines on a daily basis decreases the CLABSI rate as compared to the use of 10% povidone-iodine. This affects the length of a patient's stay in the hospital and delays the discharge process.

Limitations

  • Small sample (< 100)
  • Risk of bias(sample characteristics)
  • Other limitations/explanation: About 30% of patients had CVCs in the inguinal area, which is known to be associated with higher infection rates, and the percent of patients with inguinal catheters was higher in the povidone-iodine group. There was high attrition in the povidone-iodine group.

Nursing Implications

Nurses always are on the front line giving care to patients, and it is their responsibility to prevent the transmission of infection and provide quality care. One of the most certain ways of giving an infection to a patient is through a central line. These findings suggest that the use of 1% CHG-EtOH while manipulating central lines helps decrease the chance of CVC site contamination and may be more effective than povidone-iodine. However, study limitations reduce the strength of this particular finding. Additional studies of the most effective methods for skin preparation would be helpful.