Evaluation of the preventive effect of skin disinfection using an alcohol preparation containing 1% chlorhexidine glucoronate against dialysis catheter-related infections

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  • Hanyu Rika
    Department of Nursing, Kanazawa Medical University Hospital
  • Fujimoto Keiji
    Department of Nephrology, School of Medicine, Kanazawa Medical University
  • Ikeda Asami
    Department of Nursing, Kanazawa Medical University Hospital
  • Iida Emi
    Department of Nursing, Kanazawa Medical University Hospital
  • Yamaguchi Yuriko
    Department of Nursing, Kanazawa Medical University Hospital
  • Maeda Kazumi
    Department of Nursing, Kanazawa Medical University Hospital
  • Yokoyama Hitoshi
    Department of Nephrology, School of Medicine, Kanazawa Medical University

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Other Title
  • 1%クロルヘキシジングルコン酸塩含有アルコール製剤を用いた皮膚消毒による透析用カテーテル感染抑制効果の検討
  • 1%クロルヘキシジングルコン サンエン ガンユウ アルコール セイザイ オ モチイタ ヒフ ショウドク ニ ヨル トウセキヨウ カテーテル カンセン ヨクセイ コウカ ノ ケントウ

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Abstract

<p>【Objective and Subjects】The Centers for Disease Control and Prevention (CDC) of the United States strongly recommends skin disinfection using an alcohol preparation containing chlorhexidine glucoronate at a concentration exceeding 0.5% (chlorhexidine alcohol solution: CH-AL) before catheter insertion and during dressing changes to prevent intravascular catheter-related infections. However, no established evidence concerning the use of CH-AL in hemodialysis patients has been obtained in Japan. In a retrospective cohort study, we evaluated whether 1% CH-AL is more effective than 10% povidone iodine (PVP-I) at preventing hemodialysis catheter-related infections. The subjects were 123 patients that had been implanted with chronic hemodialysis catheters (79 in the CH-AL group, 44 in the PVP-I group). 【Results】The incidence of hemodialysis catheter-related infections was significantly lower in the 1% CH-AL group than in the 10% PVP-I group (8.9 vs. 22.7%, respectively; p=0.033). An evaluation using the Kaplan-Meier method confirmed that the frequency of catheter-related infections was significantly lower in the 1% CH-AL group than in the 10% PVP-I group (log-rank test, p=0.025). Furthermore, multivariate Cox regression analysis involving the presence/absence of 1% CH-AL use, age, sex, the presence/absence of diabetes mellitus, the catheter insertion site, and catheter type as explanatory variables showed that the use of 1% CH-AL was the only factor that significantly affected the occurrence of catheter-related infections (p=0.046). 【Conclusion】1% CH-AL might be more effective at preventing hemodialysis catheter-related infections than 10% PVP-I.</p>

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