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Effect of skin antiseptic solutions on the incidence of catheter-related bloodstream infection: a systematic review and network meta-analysis

  • Author Footnotes
    † These authors contributed equally to this manuscript.
    T. Masuyama
    Footnotes
    † These authors contributed equally to this manuscript.
    Affiliations
    Department of Anaesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan
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  • Author Footnotes
    † These authors contributed equally to this manuscript.
    H. Yasuda
    Correspondence
    Corresponding author. Address: Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama 330-8503, Japan.
    Footnotes
    † These authors contributed equally to this manuscript.
    Affiliations
    Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan

    Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Centre, Tokyo, Japan
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  • M. Sanui
    Affiliations
    Department of Anaesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan
    Search for articles by this author
  • A.K. Lefor
    Affiliations
    Department of Surgery, Jichi Medical University, Tochigi, Japan
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  • Author Footnotes
    † These authors contributed equally to this manuscript.
Published:January 29, 2021DOI:https://doi.org/10.1016/j.jhin.2021.01.017

      Summary

      Background

      The most effective skin antiseptic solution to reduce the incidence of catheter-related bloodstream infections (CRBSI) remains unknown.

      Aim

      To compare solutions with different chlorhexidine (CHG)-based concentrations and povidone-iodine (PVI) in adults with a central venous catheter (CVC) or arterial catheter, and identify an association with the incidence of CRBSI.

      Methods

      This study evaluated randomized controlled trials comparing CHG and PVI antiseptic agents in patients aged ≥18 years with an underlying illness and a CVC or arterial catheter. The primary outcome was CRBSI rate. Network meta-analysis was performed by a frequentist-based approach with multi-variate random effects meta-analysis, and the effect size was expressed as relative risk (RR) with 95% confidence interval (CI).

      Findings

      The search yielded 1511 records, of which five studies (2815 catheters) were included in the network meta-analysis. The risk of CRBSI was significantly lower with 1% CHG-alcohol than with 0.5% CHG-alcohol (RR 0.40, 95% CI 0.16–0.98; high certainty) or 10% PVI-aqueous (RR 0.31, 95% CI 0.15–0.63; high certainty). There was no significant difference in the risk of CRBSI between 1% CHG-alcohol and 2% CHG-aqueous (RR 0.35, 95% CI 0.12–1.04; moderate certainty) or other antiseptic solutions. The hierarchy of efficacy in reducing CRBSI was 1% CHG-alcohol, 0.5% CHG-alcohol, 2% CHG-aqueous and 10% PVI-aqueous.

      Conclusion

      Antiseptic agents containing 1% CHG-alcohol were more strongly associated with reduced risk for CRBSI compared with agents containing 0.5% CHG-alcohol or 10% PVI-aqueous.

      Keywords

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