Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children - A randomized, controlled trial

Background: Chlorhexidine is better than povidone iodine for skin preparati on before intravascular device insertion or blood culture collection, but I t is not known whether chlorhexidine is superior in reducing colonization o f continuous epidural catheters. Methods: Children requiring an epidural catheter for postoperative analgesi a 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% p ovidone iodine before catheter insertion. Using surgical aseptic techniques , catheters were inserted into either the lumbar or the thoracic epidural s pace based on the preferences of the anesthesia team, on clinical indicatio n, or both. Immediately before epidural catheter removal, their insertion s ite and hub were qualitatively cultures, After their removal, the catheter tips were quantitatively cultured. Catheters were classified as colonized w hen 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 si milar 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 coloniz ed 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 microorga nisms recovered, and the skin surrounding the catheter insertion site was t he origin of all the colonizing microorganisms, Conclusions: Compared with aqueous povidone iodine, the use of alcoholic ch lorhexidine for cutaneous antisepsis before epidural catheter insertion red uces the risk of catheter colonization in children.