Efficacy of Adding 2% (w/v) Chlorhexidine Gluconate to 70% (v/v) Isopropyl Alcohol for Skin Disinfection Prior to Peripheral Venous Cannulation

2008 ◽  
Vol 29 (10) ◽  
pp. 963-965 ◽  
Author(s):  
Heather Small ◽  
Debra Adams ◽  
Anna L. Casey ◽  
Cynthia T. Crosby ◽  
Peter A. Lambert ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Isopropyl Alcohol ◽  
Venous Catheter ◽  
Chlorhexidine Gluconate ◽  
Venous Cannulation ◽  
Catheter Colonization ◽  
Peripheral Venous Catheter ◽  
Skin Disinfection

We undertook a clinical trial to compare the efficacy of 2% (w/v) chlorhexidine gluconate in 70% (v/v) isopropyl alcohol with the efficacy of 70% (v/v) isopropyl alcohol alone for skin disinfection to prevent peripheral venous catheter colonization and contamination. We found that the addition of 2% chlorhexidine gluconate reduced the number of peripheral venous catheters that were colonized or contaminated.

The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients

2020 ◽  
Vol 29 (2) ◽  
pp. S24-S26 ◽  
Author(s):  
R. Marty Cooney ◽  
Nisha Manickam ◽  
Paul Becherer ◽  
Laura S. Harmon ◽  
Liza Gregg ◽  
...  
Keyword(s):  
Vascular Grafts ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
P Value ◽  
Dialysis Patients ◽  
Skin Disinfection ◽  
Confounding Variables ◽  
Inpatient Population

Purpose: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. Methods: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. Results: The 5-year preintervention period (2008–2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013–2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. Limitations: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. Conclusions: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG

scholarly journals Safety and efficacy of 2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheter insertion in preterm neonates: the ARCTIC randomised-controlled feasibility trial protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e028022 ◽  
Author(s):  
Paul Clarke ◽  
Jean V Craig ◽  
John Wain ◽  
Catherine Tremlett ◽  
Louise Linsell ◽  
...  
Keyword(s):  
Large Scale ◽  
Controlled Trial ◽  
Venous Catheter ◽  
Chlorhexidine Gluconate ◽  
Feasibility Trial ◽  
Preterm Neonates ◽  
Central Venous ◽  
Skin Disinfection ◽  
Randomised Controlled ◽  
Catheter Colonisation

IntroductionCatheter-related sepsis is one of the most dangerous complications of neonatal intensive care and is associated with significant morbidity and mortality. Use of catheter-care ‘bundles’ has reduced the incidence of catheter-related sepsis, although individual components have not been well studied. Better evidence is needed to guide selection of the most appropriate antiseptic solution for skin disinfection in preterm neonates. This study will inform the feasibility and design of the first randomised controlled trial to examine the safety and efficacy of alcohol-based versus aqueous-based chlorhexidine antiseptic formulations for skin disinfection prior to percutaneous central venous catheterisation in preterm neonates. The antiseptics to be compared are 2% chlorhexidine gluconate (CHG) aqueous and 2% CHG in 70% isopropyl alcohol.Methods and analysisThe Antiseptic Randomised Controlled Trial for Insertion of Catheters (ARCTIC) is a two-centre randomised-controlled feasibility trial. At least 100 preterm infants born at <34 weeks’ gestation and due to undergo percutaneous insertion of a central venous catheter will be randomly allocated to receive prior skin disinfection with one of the two antiseptic solutions. Outcomes include: i) recruitment and retention rates; ii) completeness of data collection; iii) numbers of enrolled infants meeting case definitions for definite catheter-related sepsis, catheter-associated sepsis and catheter colonisation and iv) safety outcomes of skin morbidity scores recorded daily from catheter insertion until 48 hours post removal. The key feasibility metrics will be reported as proportions with 95% CIs. Estimated prevalence of catheter colonisation will allow calculation of sample size for the large-scale trial. The data will inform whether it will be feasible to progress to a large-scale trial.Ethics and disseminationARCTIC has been approved by the National Health Service Health Research Authority National Research Ethics Service Committee East of England (Cambridge South) (IRAS ID 163868), was adopted onto the National Institute of Health Research Clinical Research Network portfolio (CPMS ID 19899) and is registered with an International Standard Randomised Control Trials Number (ISRCTN: 82571474; Pre-results) and European Clinical Trials Database number 2015-000874-36. Dissemination plans include presentations at scientific conferences, scientific publications and sharing of the findings with parents via the support of Bliss baby charity.Trial registration numberISRCTN82571474; Pre-results.

Alcohol-impregnated caps and ambulatory central-line–associated bloodstream infections (CLABSIs): A randomized clinical trial

2020 ◽  
pp. 1-9
Author(s):  
Aaron M. Milstone ◽  
Carol Rosenberg ◽  
Gayane Yenokyan ◽  
Danielle W. Koontz ◽  
Marlene R. Miller ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Isopropyl Alcohol ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Ambulatory Setting ◽  
Oncology Patients ◽  
Pediatric Hematology ◽  
Standard Practices ◽  
The Impact

Abstract Objective: To evaluate the effect of 70% isopropyl alcohol–impregnated central venous catheter caps on ambulatory central-line–associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients. Design: This study was a 24-month, cluster-randomized, 2 period, crossover clinical trial. Setting: The study was conducted in 15 pediatric healthcare institutions, including 16 pediatric hematology-oncology clinics. Participants: All patients with an external central line followed at 1 of the 16 hematology-oncology clinics. Intervention: Usual ambulatory central-line care per each institution using 70% isopropyl alcohol–impregnated caps at home compared to usual ambulatory central-line care in each institution without using 70% isopropyl alcohol–impregnated caps. Results: Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no reduction in CLABSI incidence in clinics using 70% isopropyl alcohol–impregnated caps (1.23 per 1,000 days) compared with standard practices (1.38 per 1,000 days; adjusted incidence rate ratio [aIRR], 0.83; 95% CI, 0.63–1.11). In the per-protocol population, there was a reduction in positive blood culture incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.51 per 1,000 days) compared with standard practices (1.88 per 1,000 days; aIRR, 0.72; 95% CI, 0.52–0.99). No adverse events were reported. Conclusions: Isopropyl alcohol–impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures. Larger trials are needed to elucidate the impact of 70% isopropyl alcohol–impregnated caps in the ambulatory setting. Registration: ClinicalTrials.gov; NCT02351258

scholarly journals Comparison of alcohol, povidone-iodine and octenidine dihydrochloride as skin disinfectants to reduce bacterial count prior to peripheral venous catheter insertions in newborn infants

2011 ◽  
Vol 51 (5) ◽  
pp. 277 ◽  
Author(s):  
Lily Rundjan ◽  
Rinawati Rohsiswatmo ◽  
Sarah Rafika ◽  
Enty Enty ◽  
Lucky H. Moehario
Keyword(s):  
Povidone Iodine ◽  
Newborn Infants ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Bacterial Count ◽  
Peripheral Venous Catheter ◽  
Skin Bacteria ◽  
Skin Disinfection ◽  
Octenidine Dihydrochloride ◽  
Before And After

AbstractBackground Vascular access may increase the risk of bloodstream infections, especially in newborn infants with weak immune systems and requiring invasive supportive care. Skin disinfection prior to peripheral venous catheter insertion lowers the risk of infection. However, antiseptics chosen for this task should be effective and safe for newborn infants.Objective To compare the effectiveness of 70% alcohol (BD alcohol swabs ®), 10% povidone-iodine (Pharma-RSUPNCM), and octenidine (Octenisept ®) as antiseptics for reducing skin bacteria for pre-invasive procedures in neonates.Methods Infants aged less than 28 days, regardless of gestational age, at the Neonatal Unit of Cipto Mangunkusumo Hospital (RSUPNCM) were included in our study. Infants were divided into three groups, each tested with different skin antiseptics (alcohol, povidone-iodine or octenidine). Skin swabs were performed before and after application of skin antiseptic, followed by inoculation onto blood agar plates. Colony-forming units were counted after 18 hours of incubation at 37ºC.Results Ninety subjects were divided into 3 groups of 30, each group using either 70% alcohol swabs, 10% povidone-iodine, or octenidine as skin antiseptic. Skin swabs were taken before and after antiseptic application and drying, as well as 5 minutes after application. The mean reductions in CFU/cm2 (%) after antiseptic application (and fully dried) were 97.54% for povidone-iodine, 97.52% for octenidine, and 89.07% for alcohol. There were no significant differences in mean CFU reductions among the three antiseptics groups (P=0.299). Furthermore, 5 minutes after application, there were still no significant differences in the three antiseptic groups (P=0.289).Conclusions Although octenidine showed a significant bacterial count reduction after application, it was not significantly different from those of alcohol or povidone-iodine. [Paediatr Indones. 2011;51:277-81].

scholarly journals Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 611
Author(s):  
Aitana Guanche-Sicilia ◽  
María Sánchez-Gómez ◽  
María Castro-Peraza ◽  
José Rodríguez-Gómez ◽  
Juan Gómez-Salgado ◽  
...  
Keyword(s):  
Venous Catheter ◽  
Venous Access ◽  
Medication Administration ◽  
Volume Control ◽  
Nursing Interventions ◽  
Intravenous Therapy ◽  
Treatment Protocols ◽  
Peripheral Venous Catheter ◽  
Treatment And Prevention ◽  
Prevention And Treatment

The objective of this work was to identify available evidence on nursing interventions for the prevention and treatment of phlebitis secondary to the insertion of a peripheral venous catheter. For this, a scoping systematic review was carried out following the guidelines in the PRISMA declaration of documents published between January 2015 and December 2020. The search took place between December 2020 and January 2021. Scielo, Pubmed, Medline, Scopus, WOS, CINHAL, LILACS, and Dialnet databases were consulted, and CASPe, AGREE, and HICPAC tools were used for the critical reading. A total of 52 studies were included to analyze nursing interventions for treatment and prevention. Nursing interventions to prevent phlebitis and ensure a proper catheter use included those related to the maintenance of intravenous therapy, asepsis, and choosing the dressing. With regard to the nursing interventions to treat phlebitis, these were focused on vigilance and caring and also on the use of medical treatment protocols. For the prevention of phlebitis, the highest rated evidence regarding asepsis include the topical use of >0.5% chlorhexidine preparation with 70% alcohol or 2% aqueous chlorhexidine, a proper hygienic hand washing, and the use clean gloves to handle connections and devices. Actions that promote the efficacy and safety of intravenous therapy include maintenance of venous access, infusion volume control, verification of signs of phlebitis during saline solution and medication administration, and constant monitoring. It is recommended to remove any catheter that is not essential. Once discharged from hospital, it will be necessary to warn the patient about signs of phlebitis after PVC removal.

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