Abstract:

Background: The most effective skin antiseptic solution to reduce the incidence of catheter-related bloodstream infections (CRBSIs) remains unknown.

Aim: To compare solutions with different chlorhexidine (CHG)-based concentrations and povidone-iodine (PVI) in adults with a central venous catheter (CVC) or arterial catheter and identify an association with the incidence of CRBSI.

Methods: This study evaluated randomized controlled trials comparing CHG and PVI antiseptic agents in patients ≥18 years old with an underlying illness and a CVC or arterial catheter. The primary outcome was CRBSI rate. Network meta-analysis was performed by a frequentist-based approach with multivariate random effects meta-analysis, and the effect size was expressed as relative risk with 95% confidence interval.

Findings: The search yielded 1,511 records, of which five studies (2,815 catheters) were included for network meta-analysis. The CRBSI risk was significantly lower with 1% CHG-alcohol than with 0.5% CHG-alcohol (relative risk, 0.40; 95% confidence interval, 0.16–0.98; high certainty) or 10% PVI-aqueous (relative risk, 0.31; 95% confidence interval, 0.15–0.63; high certainty). There was no significant difference in CRBSI risk between 1% CHG-alcohol and 2% aqueous CHG (relative risk, 0.35; 95% confidence interval, 0.12–1.04]; moderate certainty) or other antiseptic solutions. The hierarchy of efficacy in reducing CRBSI s was 1% CHG-alcohol, followed by 0.5% CHG-alcohol, 2% aqueous CHG, and 10% PVI-aqueous.

Conclusion: This study showed that antiseptic agents containing 1% CHG-alcohol are more associated with a reduced risk of CRBSI than agents containing 0.5% CHG-alcohol or 10% PVI-aqueous.

Reference:

Masuyama, Tomoyuki et al. The effect of skin antiseptic solutions on the incidence of catheter-related bloodstream infection: a systematic review and network meta-analysis. Journal of Hospital Infection, 29th January 2021. DOI: https://doi.org/10.1016/j.jhin.2021.01.017