Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection

A multicenter prospective, randomized, controlled trial, with 0.5% tincture of chlorhexidene versus 10% povidone-iodine as cutaneous antisepsis for ce ntral venous catheter (CVC) insertion, was conducted for patients in intens ive care units. Of 374 patients, 242 had a CVC inserted for >3 days and wer e used for the primary analysis. Outcomes included catheter-related bactere mia, significant catheter colonization (greater than or equal to 15 colony- forming units [cfu]), exit-site infection, serial quantitative exit-site cu lture (every 72 h), and molecular subtyping of all isolates. Patients in bo th study groups were comparable with respect to age, sex, underlying diseas e, length of hospitalization, reason for line insertion, and baseline APACH E II score. Documented catheter-related bacteremia rates were 4.6 cases per 1000 catheter-days in the chlorhexidine group (n = 125) and 4.1 cases per 1000 catheter-days in the povidone-iodine group (n = 117; not significant [ NS]), Significant catheter-tip colonization occurred in 24 (27%) of 88 pati ents in the povidone-iodine group and in 31 (34%) of 92 patients in the chl orhexidine group (NS), A mean exit-site colony count of 5.9 X 10(5) cfu/mL per 25 cm(2) of the surface area of skin in the povidone-iodine group versu s 3.1 X 10(5) cfu/mL per 25 cm(2) in the chlorhexidine group (NS) was found . There was a trend toward fewer exit-site infections in the chlorhexidine group (0 of 125 patients) versus those in the povidone-iodine group (4 of 1 17 patients; P = .053), Results of an intention-to-treat analysis were unch anged from the primary analysis. No difference was demonstrable between 0.5 % tincture of chlorhexidine and 10% povidone-iodine when used for cutaneous antisepsis for CVC insertion in patients in the intensive care unit.