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.