Friday October 13, 2006
Betdadine or Chlorhexidin ?

It is so true that scientific knowledge takes on average 17 years to travel from bench to bedside. Most of us grew up using Betadine (povidone-iodine) for bedside procedures but Dennis Maki published a study about 15 years ago in Lancet 1 randomizing solutions for skin preparation for 668 catheters, comparing 2% chlorhexidine, 10% povidone-iodine (betadine), and 70% alcohol. Chlorhexidine was associated with the lowest incidence of catheter-related-blood-stream-infections (CRBSI) with 2.3 per 100 catheters followed by Alcohol with 7.1 and povidone-iodine with 9.3 infections per 100 catheters. Another meta-analysis of 8 studies involving about 4000 catheters published in 2002 confirmed the above results 2.

Centers for Disease Control (CDC) as well as IHI (Institutefor Healthcare Improvement) now recommends to use 2% chlorhexidine instead of povidone-iodine(Betadine).


Related previous pearl:
Suture at central venous catheter site - a risk?


References:

1. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. - Lancet 1991;338:339-43. Maki DG, Ringer M, Alvarado CJ.

2. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. (pdf) - Ann Intern Med 2002;136:792-801.