Comparing the Effects of Chlorhexidine 2% and Iodopovidone-alcohol on Peripheral Venous Catheter Bacterial Colonization in Preterm Neonates

Document Type : Original Article


1 Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran

2 Microbiology Department, Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, Iran

3 Social Determinants of Health Research Center and Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran


Background: Studies regarding cleansing the area with antiseptic solutions prior to catheterization in premature infants are limited. Therefore, the present study aimed to evaluate and compare the effects of chlorhexidine 2% and iodopovidone-alcohol solutions on bacterial colonization associated with the peripheral venous catheterization in premature infants.
Methods: This quasi-experimental study was conducted in 2016-2017 at a neonatal intensive care unit in Qazvin, Iran. Premature infants (N=106) were assigned to the two groups of “A” treated with chlorhexidine 2% or “B” cleaned with iodopovidone-alcohol 10%. Quantitative culture of the catheters was performed 48 hours after insertion.
Results: Our findings showed that the frequency of positive catheter tips culture was 6.6% among all the samples (N=7). Out of the seven positive cultures, five (43.9%) belonged to the iodopovidone-alcohol group and two (3.7%) were from the chlorhexidine 2% group. Although a number of the positive cultures in the iodopovidone-alcohol group was higher than the chlorhexidine 2% group, this difference was not statistically significant (P=0.21).
Conclusion: Results of this study demonstrated that bacterial colony growth may be decreased when using preparatory chlorhexidine 2%, compared with iodopovidone-alcohol at no added risk to infants. We recommend further study in this regard.


1. Legemaat M, Carr PJ, van Rens RM, van Dijk M, Poslawsky IE, van den Hoogen A. Peripheral intravenous cannulation: complication rates in the neonatal population: a multicenter observational study. J Vasc Access. 2016; 17(4):360-5.
2. Stocker M, Berger TM. Arterial and central venous catheters in neonates and infants. Anaesthesist. 2006; 55(8):873-82.
 3. Fuentealba TI, Retamal CA, Ortiz CG, Perez RM. Radiographic assessment of catheters in a neonatal intensive care unit (NICU). Rev Chil Pediatr. 2014; 85(6):724-30.
 4. Baik-Schneditz N, Pichler G, Schwaberger B, Mileder L, Avian A, Urlesberger B. Peripheral intravenous access in preterm neonates during postnatal stabilization: feasibility and safety. Front Pediatr. 2017; 5:171.
5. Ramasethu J. Complications of vascular catheters in the neonatal intensive care unit. Clin Perinatol. 2008; 35(1):199-222.
6. Serane T, Kothendaraman B. Incidence and risk factors of infections associated with peripheral intravenous catheters. J Infect Prev. 2016; 17(3): 115-20.
7. Safdar N, O'Horo JC, Ghufran A, Bearden A, Didier ME, Chateau D, et al. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis. Crit Care Med. 2014; 42(7):1703-13.
 8. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011; 52(9):e162-93.
 9. Maiwald M, Chan ES. The forgotten role of alcohol: a systematic review and meta-analysis of the clinical efficacy and perceived role of chlorhexidine in skin antisepsis. PloS One. 2012; 7(9):e44277. 10. Takalkar YP, Garale MN, Somasundaram S, Venkataramani K, Gothwal KN, Pandrowala SA. Comparison of efficacy of chlorhexidine alcohol scrub and povidone iodine scrub in hand cleansing in elective clean surgery. Int Surg J. 2016; 3(4):1937-41.
11. Art G. Combination povidone-iodine and alcohol formulations more effective, more convenient versus formulations containing either iodine or alcohol alone: a review of the literature. J Infus Nurs. 2005; 28(5):314-20.
 12. Leikin JB, Paloucek FP. Chlorhexidine: cationic bisbiguanide, membrane active drug in periodontal medicine structure advantages and associated adverse effects, a brief communication. World J Pharm Pharm Sci. 2015; 4(7):370-92.
 13. Paloucek FP, Leikin JB. Chlorhexidine gluconate, poisoning and toxicology handbook. 4th ed. London: Informa Healthcare; 2008. P. 183-4.
14. Garland JS, Buck RK, Maloney P, Durkin DM, TothLloyd S, Duffy M, et al. Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J. 1995; 14(6):510-6.
15. Van Esch J. Chlorhexidine reduced catheter tip colonisation more than 10% povidone-iodine in critically ill neonates. Evid Based Nurs. 2002; 5(3):73.
16. Chapman AK, Aucott SW, Gilmore MM, Advani S, Clarke W, Milstone AM. Absorption and tolerability of aqueous chlorhexidine gluconate used for skin antisepsis prior to catheter insertion in preterm neonates. J Perinatol. 2013; 33(10):768-71.
 17. Nuntnarumit P, Sangsuksawang N. A randomized controlled trial of 1% aqueous chlorhexidine gluconate compared with 10% povidone-iodine for topical antiseptic in neonates: effects on blood culture contamination rates. Infect Control Hosp Epidemiol. 2013; 34(4):430-2.
 18. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis. 2008; 46(2):274-81.
 19. Visscher M, deCastro MV, Combs L, Perkins L, Winer J, Schwegman N, et al. Effect of chlorhexidine gluconate on the skin integrity at PICC line sites. J Perinato. 2009; 29(12):802-7.
 20. Tamma PD, Aucott SW, Milstone AM. Chlorhexidine use in the neonatal intensive care unit: results from a national survey. Infect Control Hosp Epidemiol. 2010; 31(8):846-9.