Best Skin Prep Before Catheter Insertion: Chlorhexidine vs Povidone-Iodine

Study Overview

Skin antisepsis before inserting intravascular catheters is one of the biggest “make-or-break” steps for preventing catheter-related infections. This systematic review and network meta-analysis compared chlorhexidine gluconate (CHG) and povidone-iodine (PVI) across different concentrations and formulations (aqueous vs alcohol-based, and alcohol type).

The review included 16 randomised trials, covering 7,803 patients and 11,985 catheters, and looked at three key infection outcomes: catheter-related bloodstream infection, catheter tip colonisation, and local insertion-site infection.

Key Findings

• Alcohol-based beats aqueous: Across outcomes, alcohol-based antiseptics were linked with lower infection rates than aqueous formulations.
• CHG generally outperformed PVI: CHG-based prep was associated with lower infection-related outcomes compared with PVI-based options.
• Strength matters: Higher-strength CHG (?1%) performed better than lower concentrations.
• Alcohol type matters too: Isopropyl alcohol performed better than ethanol when alcohol-based products were compared.
• Side effects were uncommon and mostly mild: When reactions occurred, they were typically minor local skin irritation-type effects, and overall patterns were similar between CHG and PVI (with alcohol contributing to some irritation).

Implications

If you want the option most consistently associated with the lowest catheter-related infection outcomes, the evidence points to this direction:

Use high-concentration CHG (?1%) in isopropyl alcohol as the first-line skin antiseptic before intravascular catheter insertion.

Alcohol-based PVI or aqueous options may still be useful when CHG or alcohol can’t be used—but they appear less effective overall for infection prevention. The big takeaway: it’s not just “CHG vs PVI” — the formulation and concentration make a real difference.

Read More:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2844975 

Authors: Bertrand Drugeon; Gabor Mihala; Jessica Schults; Benjamin Bigaud; Jérémy Guenezan; Guillaume Batiot; Natalie Barker; Nicolas Marjanovic; Niccolò Buetti; Olivier Mimoz.