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Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a
B Kinirons1, O Mimoz, L Lafendi
1Department of Anesthesia and Intensive Care, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
Insights
Alcoholic chlorhexidine significantly reduced epidural catheter colonization in children compared to povidone iodine. This finding supports chlorhexidine use for preventing catheter-related infections in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Infectious Disease Prevention
- Medical Device Management
Background:
- Chlorhexidine demonstrates superior skin antisepsis compared to povidone iodine for certain procedures.
- Evidence is lacking on chlorhexidine's efficacy in preventing continuous epidural catheter colonization.
Purpose of the Study:
- To compare the efficacy of alcoholic chlorhexidine versus aqueous povidone iodine in reducing epidural catheter colonization in children.
Main Methods:
- Randomized controlled trial involving children requiring epidural catheters for >24 hours.
- Skin preparation with either 0.5% chlorhexidine or 10% povidone iodine before catheter insertion.
- Quantitative and qualitative cultures of catheter insertion sites and tips post-removal.
Main Results:
- 96 children were evaluable; groups were clinically similar.
- Chlorhexidine preparation resulted in significantly lower catheter colonization rates (0.9 per 100 catheter days vs. 5.6 per 100 catheter days).
- Coagulase-negative staphylococci were the sole colonizing organisms, originating from the skin.
Conclusions:
- Alcoholic chlorhexidine is more effective than aqueous povidone iodine in reducing epidural catheter colonization in pediatric patients.
- This study supports the use of chlorhexidine for skin antisepsis prior to epidural catheter insertion to minimize infection risk.
Background:
Chlorhexidine is better than povidone iodine for skin preparation before intravascular device insertion or blood culture collection, but it is not known whether chlorhexidine is superior in reducing colonization of continuous epidural catheters.
Methods:
Children requiring an epidural catheter for postoperative analgesia longer than 24 h were randomly assigned to receive skin preparation with an alcoholic solution of 0.5% chlorhexidine or an aqueous solution of 10% povidone iodine before catheter insertion. Using surgical aseptic techniques, catheters were inserted into either the lumbar or the thoracic epidural space based on the preferences of the anesthesia team, on clinical indication, or both. Immediately before epidural catheter removal, their insertion site and hub were qualitatively cultures. After their removal, the catheter tips were quantitatively cultured. Catheters were classified as colonized when their tips yielded 1,000 or more colony-forming units/ml in cultures.
Results:
Of 100 randomly assigned patients, 96 were evaluable. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters were kept in place for a median (range) duration of 50 (range, 21-100) h. Catheters inserted after skin preparation with chlorhexidine were one sixth as likely and less quickly to be colonized as catheters inserted after skin preparation with povidone iodine (1 of 52 catheters [0.9 per 100 catheter days] vs. 5 of 44 catheters [5.6 per 100 catheter days]; relative risk, 0.2 [95% confidence interval, 0.1-1.0]; P = 0.02). Coagulase-negative staphylococci were the only colonizing microorganisms recovered, and the skin surrounding the catheter insertion site was the origin of all the colonizing microorganisms.
Conclusions:
Compared with aqueous povidone iodine, the use of alcoholic chlorhexidine for cutaneous antisepsis before epidural catheter insertion reduces the risk of catheter colonization in children.