Korean J Clin Microbiol.  2012 Mar;15(1):37-42. 10.5145/KJCM.2012.15.1.37.

Comparison of Chlorhexidine-Alcohol and Povidone-Iodine for Skin Antisepsis and the Effect of Increased Blood Volume in Blood Culture

• Kang H
• Kim SC
• Kim S

• KMID: 2224859
• DOI: http://doi.org/10.5145/KJCM.2012.15.1.37

Abstract

BACKGROUND
Reducing skin contamination rate and improving the positive rate in blood culture is essential for the correct diagnosis and management of sepsis. Chlorhexidine-alcohol was compared with povidone-iodine for the efficiency of disinfection. Positive rates were compared between the collection of 10 mL and 20 mL of blood per sample.
METHODS
The study population included adult patients > or = 18 years old requested for blood culture in the Emergency Department. Povidone-iodine (10%) was used for antiseptic skin preparation from March to June 2011, and 0.5% chlorhexidine-alcohol from July to October 2011. The standard for blood collection was 10 mL in the first period and 20 mL in the second period. The dedicated phlebotomists had been educated on the optimal skin preparation and sample collection.
RESULTS
After 10% povidone-iodine application, 31 of 2,755 samples (1.1%) were considered to be contaminated; whereas, a total of 60 of 3,064 samples (2.0%) were contaminated (P=0.011) after application of 0.5% chlorhexidine-alcohol. The positive rate of blood culture was 12.5% (345/2,755) in the first period versus 17.1% (524/3,064) in the second period (P<0.001).
CONCLUSION
Both disinfectants appeared acceptable for skin preparation for blood culture collection, although chlorhexidine-alcohol had a higher contamination rate than povidone-iodine. The positive rate of blood culture was in accordance with the amount of sample collected. Continuous education and monitoring are needed for the proper collection and management of blood culture.

Keyword

Bloodstream infections; Disinfectant

MeSH Terms

Adult
Antisepsis
Blood Volume
Disinfectants
Disinfection
Emergencies
Humans
Povidone-Iodine
Sepsis
Skin
Disinfectants
Povidone-Iodine

Figure

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  Fig. 1 Contamination rates with skin normal flora using 10% povidone-iodine and 0.5% chlorhexidine-alcohol (P<0.05).

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  Fig. 2 Positive rates obtained with the protocol of 10 mL and 20 mL collection per set (P<0.05).

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