Basic Bundle

  • Hand hygeine
  • Surgical asepsis insertion conditions
  • Avoid aqueous iodine
  • Subclavian and radial preferred
  • Remove useless catheters
  • Immediate change of soiled dressings

What about alcohol-iodine versus chlorhexidine-alcohol? Scrubbing or no-scrubbing of line areas?

2×2 factorial design

Muticentre RCT, primary outcome CRBSI

2349 enrolled with 5159 catheters!

Patients generally matched, mainly medical patients with 70% mechanically ventilated

Most patients had radial catheters (68%)

Chlorhexidine was significantly better than alcohol-PVI in reducing CRBSI. Addition of scrubbing of area added no real benefit. Chlorhexidine group had more skin reactions but they were slight.

Conclusion: 2% chlorhexidine is superior to iodine in reducing the risk of CRBSI

Skin antisepsis with chlorhexidine–alcohol versus povidone iodine–alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial