Chlorhexidine vs Povidone-Iodine for Catheter Infection Prevention: Which Is Better?

Study Overview

This narrative review explores the comparative effectiveness of two common antiseptics—chlorhexidine gluconate (CHG) and povidone-iodine (PVI)—for skin disinfection before catheter insertion. With billions of catheters inserted annually and catheter-related infections posing serious risks, effective antiseptic use is essential. The review considers antimicrobial efficacy, resistance, environmental impact, safety, and cost.

Key Findings

Efficacy: 2% CHG in 70% alcohol is more effective than PVI in preventing catheter-related infections (CRIs), especially in central venous catheters.

Safety: CHG may cause more skin irritation or allergy (rare anaphylaxis), while PVI carries a risk of thyroid dysfunction in neonates.

Resistance: CHG shows in vitro resistance mechanisms (efflux pumps, biofilm resistance), but no confirmed clinical impact. PVI has no known resistance.

Environmental Impact: CHG is more environmentally persistent and harmful to aquatic life than PVI.

Cost: While CHG is more expensive, it may be more cost-effective long-term due to fewer infections.

Implications

CHG-alcohol remains the gold standard for most patients. PVI remains useful for CHG-intolerant individuals or low-resource settings. The authors call for:

1. Broader standardisation of CHG use.
2. Tailored guidance for high-risk populations (e.g., neonates).
3. Consideration of environmental and cost factors in clinical guidelines.

Read more:https://www.sciencedirect.com/science/article/pii/S187603412500200X?via%3Dihub 

Authors: Bertrand Drugeon, Claire M. Rickard, Jessica A. Schults, Jérémy Guenezan, Olivier Mimoz