• T Masuyama, H Yasuda, M Sanui, and A K Lefor.
• Department of Anaesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan.
• J. Hosp. Infect. 2021 Apr 1; 110: 156-164.

BackgroundThe most effective skin antiseptic solution to reduce the incidence of catheter-related bloodstream infections (CRBSI) remains unknown.AimTo compare solutions with different chlorhexidine (CHG)-based concentrations and povidone-iodine (PVI) in adults with a central venous catheter (CVC) or arterial catheter, and identify an association with the incidence of CRBSI.MethodsThis study evaluated randomized controlled trials comparing CHG and PVI antiseptic agents in patients aged ≥18 years with an underlying illness and a CVC or arterial catheter. The primary outcome was CRBSI rate. Network meta-analysis was performed by a frequentist-based approach with multi-variate random effects meta-analysis, and the effect size was expressed as relative risk (RR) with 95% confidence interval (CI).FindingsThe search yielded 1511 records, of which five studies (2815 catheters) were included in the network meta-analysis. The risk of CRBSI was significantly lower with 1% CHG-alcohol than with 0.5% CHG-alcohol (RR 0.40, 95% CI 0.16-0.98; high certainty) or 10% PVI-aqueous (RR 0.31, 95% CI 0.15-0.63; high certainty). There was no significant difference in the risk of CRBSI between 1% CHG-alcohol and 2% CHG-aqueous (RR 0.35, 95% CI 0.12-1.04; moderate certainty) or other antiseptic solutions. The hierarchy of efficacy in reducing CRBSI was 1% CHG-alcohol, 0.5% CHG-alcohol, 2% CHG-aqueous and 10% PVI-aqueous.ConclusionAntiseptic agents containing 1% CHG-alcohol were more strongly associated with reduced risk for CRBSI compared with agents containing 0.5% CHG-alcohol or 10% PVI-aqueous.Copyright © 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

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