Implementation of chlorhexidine gluconate for central venous catheter site care at Siriraj Hospital, Bangkok, Thailand

BACKGROUND: A meta-analysis and cost-effectiveness analysis of randomized controlled trials comparing chlorhexidine gluconate with povidone-iodine solutions for venous catheter site care found that the use of chlorhexidine gluconate significantly reduced the risk for catheter-related bloodstream infections and that it was cost-effective. The objective of the study was to implement locally formulated chlorhexidine gluconate for central venous catheter (CVC) site care in intensive care units (ICUs) at Siriraj Hospital. METHODS: The study was conducted in 312 subjects who needed CVC insertions in 3 ICUs from January to July 2006. One hundred twenty subjects received 2% chlorhexidine gluconate in 70% alcohol, whereas 192 subjects received 10% povidone-iodine as the antiseptic solution for CVC site care. The patients were assessed for CVC-related infections and for any adverse effects of 2% chlorhexidine gluconate in 70% alcohol. RESULTS: The incidence of CRBSIs in the indwelling CVC subjects who received 2% chlorhexidine gluconate in 70% alcohol was less than those who received 10% povidone-iodine during the same period, 3.2 versus 5.6 episodes per 1000 CVC days, respectively (P= .06; OR, 3.26; 95% CI: 0.97-10.92). No adverse effects related to using 2% chlorhexidine gluconate in 70% alcohol were observed. CONCLUSION: The locally formulated 2% chlorhexidine gluconate in 70% alcohol was safe, effective, and efficient for CVC site care in ICUs at Siriraj Hospital.