Chlorhexidine Compared with Povidone-Iodine as Skin Preparation before Blood Culture

Chlorhexidine Compared with Povidone-Iodine as Skin Preparation before Blood Culture

A Randomized, Controlled Trial

Olivier Mimoz, MD, PhD;
Amal Karim, PharmD;
Alain Mercat, MD;
Marie Cosseron, MD;
Bruno Falissard, MD, PhD;
Fabrice Parker, MD, PhD;
Christian Richard, MD;
Kamran Samii, MD; and
Patrice Nordmann, MD, PhD

From the Université Paris XI, Hôpital de Bicêtre, and Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre Cedex, France.

Abstract

Background: Chlorhexidine is better than povidone-iodine for care of catheter sites, but it is not known whether chlorhexidine is superior in reducing blood culture contamination.

Objective: To determine whether alcoholic chlorhexidine is a more effective skin antiseptic for collection of blood cultures than aqueous povidone-iodine.

Design: Randomized, controlled trial.

Setting: Three adult intensive care units in a French university hospital.

Patients: 403 adults who had at least one blood culture drawn through a peripheral vein.

Interventions: Patients were randomly assigned to receive skin preparation with an aqueous solution of 10% povidone-iodine or an alcoholic solution of 0.5% chlorhexidine before phlebotomy.

Measurements: Contamination rates of blood cultures.

Results: Of 2041 blood cultures collected in 403 patients, 124 yielded pathogens. Chlorhexidine reduced the incidence of blood culture contamination more than povidone-iodine (14 of 1019 cultures [1.4%] compared with 34 of 1022 cultures [3.3%]; odds ratio, 0.40 [95% CI, 0.21 to 0.75]; P = 0.004).

Conclusion: Skin preparation with alcoholic chlorhexidine is more efficacious than skin preparation with aqueous povidone-iodine in reducing contamination of blood cultures.

Article and Author Information

Acknowledgments: The authors thank the patients, physicians, and nurses of Hôpital Bicêtre for their cooperation and assistance.
Grant Support: By Zeneca Pharma and University Paris XI (UPRES, JE 2227).
Requests for Reprints: Olivier Mimoz, MD, PhD, Service d'Anesthésie-Réanimation, Hôpital Paul Brousse, 10 avenue Paul-Vaillant Couturier, 94809 Villejuif Cedex, France.
Current Author Addresses: Dr. Mimoz: Service d'Anesthésie-Réanimation, Hôpital Paul Brousse, 10 avenue Paul-Vaillant Couturier, 94809 Villejuif Cedex, France.
Drs. Karim, Cosseron, and Nordmann: Service de Bactériologie-Virologie, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France.
Drs. Mercat and Richard: Service de Réanimation Médicale, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France.
Dr. Falissard: INSERM-U472, Hôpital Paul Brousse, 16 avenue Paul-Vaillant Couturier, 94807 Villejuif Cedex, France.
Dr. Parker: Service de Neuro-Chirurgie, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France.
Dr. Samii: Service d'Anesthésie-Réanimation Chirurgicale, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France.