Two per cent alcoholic chlorhexidine versus alcoholic five per cent povidone-iodine for the prevention of perineural catheter colonisation: The CHLOVEPI randomised, controlled trial.
Study Goal
The researchers compared the antiseptic efficacy of povidone-iodine-5% alcohol versus 2% alcoholic chlorhexidine in preventing bacterial colonization of perineural catheters in orthopedic surgery.
Results Summary
Povidone-iodine-5% alcohol was less effective than 2% alcoholic chlorhexidine in reducing bacterial colonization of perineural catheters (32.7% vs. 15.5%). No catheter-related infections or adverse effects were observed with either antiseptic.
Population
Patients undergoing orthopedic surgery with perineural catheters.
Effective Dosage
Povidone-iodine-5% alcohol (specific frequency not detailed).
Duration
Duration of catheter use varied, with ≥3 days identified as a risk factor for colonization.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
2% alcoholic chlorhexidine | decrease | catheter bacterial colonisation | patients in orthopaedic surgery | 15.5% (n=9) versus 32.7% (n=18) | was associated with a lower incidence | #1 |
2% alcoholic chlorhexidine | decrease | bacterial colonisation rates | patients with placed perineural catheters | - | decreases | #2 |
povidone-iodine-5% alcohol | increase | catheter bacterial colonisation | patients in orthopaedic surgery | 32.7% (n=18) versus 15.5% (n=9) | was associated with a higher incidence | #3 |
2% alcoholic chlorhexidine | no change | adverse effects of antiseptic solutions | patients in either group | - | No adverse effects were observed | #4 |
povidone-iodine-5% alcohol | no change | adverse effects of antiseptic solutions | patients in either group | - | No adverse effects were observed | #5 |
duration of catheter use ≥ 3 days | increase | catheter colonisation | patients | - | was associated with colonisation | #6 |
obesity | increase | catheter colonisation | patients | - | was associated with colonisation | #7 |
BACKGROUND: Multimodal analgesia, including a regional technique using perineural catheters (PNCs), is recommended for the treatment of moderate-to-severe acute postoperative pain. Perineural catheters are at risk of bacterial colonisation. In this study, we compared the cutaneous antiseptic efficacy of 2% alcoholic chlorhexidine and povidone-iodine-alcohol for preventing the bacterial colonisation of PNCs in orthopaedic surgery. METHODS: We performed a randomised, controlled trial, comparing two cutaneous antisepsis strategies, one based on 2% alcoholic chlorhexidine and the other on povidone-iodine-5% alcohol, for placed PNCs before orthopaedic surgery. The primary endpoint was the incidence of catheter bacterial colonisation (threshold > 1000 colony-forming units/ml). The secondary endpoints were the incidence of catheter-related infections and the adverse effects of the antiseptic solutions. RESULTS: From November 2016 to May 2018, we included 113 patients in this study. The use of alcoholic chlorhexidine was associated with a lower incidence of catheter colonisation (15.5% (n = 9) versus 32.7% (n = 18); OR: 0.28 [0.09-0.77], p = 0.01). No catheter-related infections or adverse effects of antiseptic solutions were observed in either group. The risk factors associated with colonisation were a duration of catheter use ≥ 3 days (p = 0.04) and obesity (p = 0.005). The most frequently identified bacterium was Staphylococcus epidermidis. CONCLUSION: Skin disinfection with 2% alcoholic chlorhexidine decreases bacterial colonisation rates for placed perineural catheters.