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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Center for Disease Control guidelines recommend that clean skin be prepared with \u0026gt;0.5% chlorhexidine in 70% isopropyl alcohol (CHX-OH) before invasive procedures. However, to date there has been insufficient data to evaluate CHX-OH compared with povidone iodine in alcohol (PVI-OH). This article presents results from a late-breaking clinical trial that suggests that the use of 1-step 2% CHX-OH without scrubbing was more effective than 4-step PVI-OH with scrubbing for preventing central venous catheter colonization.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EScreening \u0026amp; Prevention\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfectious Disease Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBacterial Infections Laboratory Techniques\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Center for Disease Control guidelines recommend that clean skin be prepared with \u0026gt;0.5% chlorhexidine in 70% isopropyl alcohol (CHX-OH) before invasive procedures. Similar preparation is recommended by the American Society of Anesthesiologists in preparation for a central venous catheter. However, to date there has been insufficient data to evaluate CHX-OH compared with povidone iodine in alcohol (PVI-OH).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EJean-Jacques Parienti, MD, PhD, Centre Hospitalier Universitaire de Caen, Caen, France, presented results from a late-breaking clinical trial suggesting that the use of 1-step 2% CHX-OH without scrubbing was more effective than 4-step PVI-OH with scrubbing for preventing central venous catheter (CVC) colonization.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe source for these data was the first 215 consecutive patients from a single center who were participating in an ongoing randomized controlled trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01478153\u0026amp;atom=%2Fspmdc%2F12%2F14%2F17.2.atom\u0022\u003ENCT01478153\u003C\/a\u003E] comparing mechanical, infectious, and thrombotic complications between 3 venous access sites (subclavian, internal jugular, and femoral veins) for CVCs in patients admitted in the intensive care unit. The subjects in the analysis presented by Dr. Parienti received surgical site preparation with 10% PVI scrub, rinse, and dry followed by 5% PVI-OH (4-step) during August 2011 to January 2012 or CHX-OH without scrubbing (1-step) during January 2012 to August 2012. The endpoints were catheter-tip colonization (\u22651000 CFU\/mL) and central line-associated bloodstream infection (CLABSI; based on systematic peripheral blood cultures at CVC removal). Baseline characteristics were similar between the 2 periods except for a trend toward more successful first insertion attempts with CHX-OH (60%) versus PVI-OH (49%), mostly due to higher use of ultrasound guided insertions during the period with CHX-OH use.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EColonization on catheter removal was significantly lower with 1-step CHX-OH compared with 4-step PVI-OH on both univariate analysis (HR, 0.12; 95% CI, 0.04 to 0.43; p\u22640.0001) and after controlling for body mass index, site, and antibiotic treatment (adjusted HR, 0.17; 95% CI, 0.05 to 0.57; p\u0026lt;0.005). Eleven of the 24 colonizations with PVI-OH (24\/106) were Gram-positive \u003Cem\u003E(Staphylococcus epidermidis\u003C\/em\u003E and \u003Cem\u003EStaphylococcus aureus\u003C\/em\u003E); 13 were Gram-negative \u003Cem\u003E(Pseudomonas aeruginosa, Escherichia coli, Enterobacter\u003C\/em\u003E spp). Of the 4 colonizations with CHX-OH, 3 were Gram-positive (all \u003Cem\u003ES. epidermidis)\u003C\/em\u003E and 1 was fungal. The study was not powered to detect a significant difference in CLABSI, but the incidence was low in both groups (2 with PVI-OH and none with CHX-OH).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe colonization rate with PVI-OH in this study (24\/106; 22.6%) was similar to that reported previously [Mimoz O et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2007; Parienti JJ et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2008] and when data from an earlier study [Parienti JJ et al. \u003Cem\u003ECrit Care Med\u003C\/em\u003E 2004] were added to the current data, the use of CHX-OH remained independently associated with a lower risk of CVC colonization (HR, 0.19; 95% CI, 0.06 to 0.54).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAlthough Dr. Parienti cautioned the current study is limited in that it represents a small number of patients from a single center, observational study, he believes that 1-step 2% CHX-OH is unlikely to be inferior to 4-step PVI-OH, but it is simpler and is safe without scrubbing for skin antisepsis in ICU patients. A large randomized clinical trial is needed and will be started in France.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/14\/17.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn9f1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}