Managing CVC-related infections : a comparison of povidone-iodine with chlorhexidine-based solutions.

Abstract

Managing CVC-related infections: A comparison of Povidone iodine with Chlorhexidine-based solutions Most critical patients have a central venous catheter (CVC) inserted, which put them at increased risk of acquiring catheter-related bloodstream infections (CRBSI). Proper skin preparation and care, will keep a clean CVC-site, thus reducing CRBSI. Studies are now comparing the effectiveness of the traditional Povidone-iodine (PI) with a Chlorhexidine-based solution with an aim to identify the solution that best reduces infection risks. To facilitate this comparison, a research (PICO) question was formulated: 'In patients with CVCs, does the use of Chlorhexidine-based solution reduce infection rates when compared with PI-based solution?' The P-Population is adult hospitalised patients having a CVC. The I-Intervention and C-Comparison are the use of Chlorhexidine-based solutions and PI, respectively. The O-Outcome is the reduction in infection rates in patients having a CVC. A literature search was carried out with an aim to answer the PICO question. The studies retrieved included meta-analysis and RCTs, comparing both PI and Chlorhexidine-based solutions in reducing eve-related infection rates. Any other evidence, not including adult patients having eves, not comparing same disinfectants in different scenarios rather than for CVC care, evidence not related to the PICO question and not written in English, were excluded. Moreover, no date restrictions were implemented. As a result, one meta-analysis and seven RCTs were retrieved and critically appraised using Critical Appraisal Skills Programme (CASP) tools. After being appraised, studies reviewed showed that Chlorhexidine-based solutions were superior to PI in reducing CVC-related infection rates. The use of Chlorhexidine-based solution is to be encouraged for CVC care, through appropriate use of care bundles, accompanied by education on Chlorhexidine use. Moreover, further research is needed for determining the most effective concentration of Chlorhexidine. Audits are also recommended for ensuring staff compliance with Chlorhexidine. Keywords: CENTRAL VENOUS CATHETER, POVIDONE-IODINE, CHLORHEXIDINE, CATHETER-RELATED BLOODSTREM INFECTION, INFECTION CONTROL, SKIN DISINFECTION B.Sc (Hons.) Nursing April 2012