Alcoholic povidone-iodine or chlorhexidine-based antiseptic for the prevention of central venous catheter-related infections: In-use comparison

To make a field comparison of the effectiveness, ease of use, and cost of a chlorhexidine antiseptic solution [CBA] and an alcohol-based povidone-iodine solution [PVP-IA] for the prevention of central venous catheter [CVC]-related infections in an intensive care unit, with the aim of identifying the superior antisepsis agent. We measured the CVC colonization and infection incidence for PVP-IA [Betadine alcoolique] and for CBA [Biseptine] during two successive 1-year periods of routine surveillance [REA RAISIN network]. A questionnaire on the ease of CBA use was administered. Consumption data were obtained from the hospital pharmacy. The study included 806 CVC [CBA period: 371]. Upon switching from PVP-IA to CBA, we recorded a significant reduction in colonization incidence/100 catheter days [1.12 vs. 1.55, p = 0.041], nonsignificant differences concerning CVC-related infection incidence/100 catheter days [0.28 vs. 0.26, p = 0.426], and a nonsignificant reduction in CVC-related bacteremia/100 catheter days [0.14 vs. 0.30, p = 0.052]. PVP-IA users were at significantly higher risk of CVC colonization or infection based on a multivariate Cox model analysis [relative risk [95% Cl]: 1.48 [1.01-2.15], p = 0.043]. The main drawbacks of CBA use were its low cleansing activity and its colorless solution. No cost advantage was found. Our field study revealed no major clinical advantage of CBA use in CVC infection and no cost advantage in addition to limited ease of use. 2011 Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. All rights reserved

Hand rub dose needed for a single disinfection varies according to product: a bias in benchmarking using indirect hand hygiene indicator

The 3 ml volume currently used as the hand hygiene [HH] measure has been explored as the pertinent dose for an indirect indicator of HH compliance. A multicenter study was conducted in order to ascertain the required dose using different products. The average contact duration before drying was measured and compared with references. Effective hand coverage had to include the whole hand and the wrist. Two durations were chosen as points of reference: 30 s, as given by guidelines, and the duration validated by the European standard EN 1500. Each product was to be tested, using standardized procedures, by three nosocomial infection prevention teams, for three different doses [3, 2 and 1.5 ml]. Data from 27 products and 1706 tests were analyzed. Depending on the product, the dose needed to ensure a 30-s contact duration in 75% of tests ranging from 2 ml to more than 3 ml, and to ensure a contact duration exceeding the EN 1500 times in 75% of tests ranging from 1.5 ml to more than 3 ml. The aftermath interpretation is the following: if different products are used, the volume utilized does not give an unbiased estimation of the HH compliance. Other compliance evaluation methods remain necessary for efficient benchmarking