- 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