Patient Safety/Quality of Care

Using chlorhexidine gluconate solution for vascular catheter site care greatly reduces the risk of catheter-related infection

More than 150 million intravascular devices are used each year in the United States. Each catheter consists of a slender tube (and any necessary connecting fittings) that is inserted in a patient's central or peripheral vein to facilitate blood sampling, monitor blood pressure, or administer fluids or medications intravenously. However, microbes that colonize the catheter hub and skin surrounding the insertion site can lead to life-threatening bloodstream infections. The good news is that use of chlorhexidine gluconate in place of the current standard solution (povidone iodine) to clean the site of catheter insertion reduces the risk of catheter-related bloodstream infection by half, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11540).

This is a simple and cost-effective way to improve patient safety in the hospital setting, concludes lead author, Nathorn Chaiyakunapruk, Pharm.D., Ph.D., of the University of Washington. He and colleagues used data from randomized, controlled trials, meta-analyses, and epidemiologic studies to construct a decision model to calculate the probability of catheter-related bloodstream infection and related costs, as well as the probability of death with use of each disinfectant on a hypothetical group of hospitalized patients requiring either a peripheral or central vascular catheter for 10 days or less.

Based on the model, they estimated that use of chlorhexidine rather than povidone reduced central catheter-related bloodstream infections by half (a decline from 31 to 15 cases per 1,000 catheters) and decreased infection-related deaths by 0.23 percent at a savings of $113 per catheter used. For peripheral site care, the results were similar, although the differences were smaller.

See "Vascular catheter site care: The clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine," by Dr. Chaiyakunapruk, David L. Veenstra, Pharm.D., Ph.D., Benjamin A. Lipsky, M.D., and others, in the September 15, 2003, Clinical Infectious Diseases 37, pp. 764-771.

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