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Chlorhexidine and Povidone Iodine are better than either alone for prevention of central venous catheter colonisation.

Citation/s: Langgartner J, et al. Combined skin disinfection with chlorhexidine/propanol and aqueous povidone iodine reduces bacterial colonization of central venous catheters. Intensive Care Medicine (2004) 30:1081-1088
Lead author's name and fax: Langgartner J, et al.

Three-part Clinical Question: Does combination skin preparation with chlorhexidine/propanol and aqueous povidone -iodine reduce the bacterial colonisation of central venous catheteres in hospital patients ?  (compared to use of either chlorhexidine or povidone iodine alone)
 

Search Terms: see summary page.

The Study: Single-blinded randomised controlled trial with intention-to-treat.
 

The Study Patients: Adult inpatients scheduled for elective CVC placement during normal working hours from normal wards and intensive care units.

Definitions:

Catheter tip colonization was defined as more than 15 colonies/plate in the semiquantitative culture of the intravascular segment.
 

Control group: 2 regimes. One was povidone-iodine 10% aqueous solution.

One was propanol 70%/chlorhexidine 0.5%.

Experimental group: 1 minute propanol 70%/chlorhexidine 0.5% for 1 minute followed by PVP iodine 10% for 1 minute.

The Evidence:

RR and NNTs

Comments:

The study was unusual in that the protocol was amended part way through the study. The duration of skin preparation  time was increased from one minute for the single prep groups to 2 minutes.
Didn't look at episodes of bloodstream infection.
Only included elective planned CVCs.
Not clear whether can be extrapolated to other situations (emergencies)

EBM questions: 

1) Do the methods allow accurate testing of the hypothesis? Yes
2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? Yes
3) Are conclusions valid in light of the results? Yes
4) Did results get omitted, and why? Yes 200 catheters were evaluated but 60 of these were excluded from the analysis. (5 patients died with catheter in place, 38 cases did not have microbiological analysis of catheter tip performed, 17 catheters lost to follow up)
5) Did they suggest areas of further research? Yes A larger confirmatory study using the same disinfection regimes to investigate the influence of  the different regimes on bloodstream infections.
6) Did they make any recommendations based on the results and were they appropriate? Yes
7) Is the study relevant to my clinical practice? Yes
8) What level of evidence does this study represent ? 1+
9) What grade of recommendation can I make on this result alone? B

10) What grade of recommendation can I make when this study is considered along with other available evidence? B
11) Should I change my practice because of these results? Possibly
12) Should I audit my current practice because of these results? Possibly

Appraised by: Andrew Longmate, Stirling Royal Infirmary; June 2005
Email: Andrew.Longmate@fvah.scot.nhs.uk

By: June 2010

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