Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial

Abstract

To compare the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation and care of central venous catheter (CVC) insertion sites, with and without octenidine dihydrochloride, a double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different skin disinfection regimens at the insertion site: 0.1% octenidine with 30% 1-propanol and 45% 2-propanol, and as control 74% ethanol with 10% 2-propanol. Endpoints were (i) skin colonization at the insertion site; (ii) positive culture from the catheter tip (> or = 15 CFU); and (iii) occurrence of CVC-associated bloodstream infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly reduced by octenidine treatment (relative difference octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p <0.0001). Positive culture of the catheter tip was significantly less frequent in the octenidine group (7.9%) than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with octenidine had a non-significant reduction in catheter-associated bloodstream infections (4.1% vs. 8.3%; OR = 0.44; 95%CI: 0.18-1.08, p 0.081). Side effects were similar in both groups. This randomized controlled trial supports the results of two observational studies demonstrating octenidine in alcoholic solution to be a better option than alcohol alone for the prevention of CVC-associated infections.

New Strategies for Preoperative Skin Antisepsis

“…While 10% aqueous povidone iodine alone is significantly less effective than alcohol-based products, the combination of povidone iodine with alcohol is only minutely less effective than alcohol combined with remanently acting compounds [6]. Similar findings have been demonstrated for other alcohol combinations with added remanent antiseptics, such as octenidine dihydrochloride [5]. …”

“…Alcohol is commonly combined with compounds that have a remanent antimicrobial efficacy, such as chlorhexidine, because of the higher antiseptic efficacy [5] and, as a consequence, decreased incidence of SSI [6]. While 10% aqueous povidone iodine alone is significantly less effective than alcohol-based products, the combination of povidone iodine with alcohol is only minutely less effective than alcohol combined with remanently acting compounds [6].…”

Clinical characteristics of Stenotrophomonas maltophilia infection in hematopoietic stem cell transplantation recipients: a single center experience

“…Special focus should be given on proper hand hygiene and skin disinfection, as demonstrated in a recent randomized controlled trial which compared the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation and care of CVC insertion sites, with and without octenidine dihydrochloride. It demonstrated that octenidine in alcoholic solution may be a better option than alcohol alone for the prevention of CVC-associated infections, due to significantly fewer positive cultures of the catheter tip and a non-significant reduction in catheter-associated bloodstream infections in the octenidine group [14]. Since all of our isolates were susceptible to TMP-SMX, this strengthens previous reports that show that TMP-SMX has the most potent in vitro activity against S. maltophilia and should probably be regarded as first line therapy [5,7].…”

Effect of perioperative mupirocin and antiseptic body wash on infection rate and causative pathogens in patients undergoing cardiac surgery

“…However, octenidine has been shown to be at least equally potent as chlorhexidine concerning its antiseptic properties and it has been successfully used as an alternative to chlorhexidine for care of the insertion site in patients with central venous catheters. [14][15][16] Furthermore, daily bathing with octenidine resulted in a reduction in carriage rate of methicillinresistant S aureus (MRSA) in intensive care patients. 17 We primarily evaluated the effect of mupirocin nasal ointment and preoperative chlorhexidine/octenidine wash on SSI rates based on our standardized prospective surveillance protocol, adjusting for potential confounding factors in a quasiexperimental study.…”