Document Type : Original Article
Authors
School of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran
Abstract
Background: Infection control is an essential part of caring for hospitalized infants. With
regard to the change of bacterial resistance over time and places, as well as the need for
periodic studies on the effectiveness of antiseptics, this study aims to compare the effects of
both solutions of povidone-iodine and chlorhexidine on skin bacterial flora among hospitalized
infants. Materials and Methods: This clinical trial recruited 98 hospitalized infants and each of
the above-mentioned solutions has been applied to a small area in the left or right side of the
infants’ bodies. Skin cultures were taken before, immediately after and 2 h after the randomly
chosen infants’ skin areas that were disinfected by each solution (588 skin cultures in total).
Colony count and determination of microorganism types were done by only one person in a
single laboratory. The study has been conducted in two teaching hospitals in Isfahan, Iran.
Results: Staphylococcus epidermidis was the most common microorganism prior to skin
disinfection by either solution. Two hours after disinfection, “Staphylococcus epidermidis” and
“Staphylococcus epidermidis and kelebsila” had the highest frequencies of 3.1% and 3.1%,
respectively. Before and 2 h after disinfection, distribution of different types of microorganisms
had no significant difference between the two groups (P = 0.84 and 0.13, respectively); however,
the difference was significant immediately after disinfection, P < 0.01. Conclusion: The present
study demonstrated that 10% povidone-iodine solution has more significant effect on reduction
of skin pathogens promptly after application compared to 2% chlorhexidine. Therefore, prior
to any catheterization procedures, it is imperative to use 10% povidone-iodine solutions for
skin disinfection.
Keywords
Care-Associated Infection Worldwide: A systematic review of the
literature. Geneva, Switzerland: World Health Organization; 2011.
2. Shams M, Nabizade-Noudehi R, Rezaei F, Mazloumi S. Evaluation
of disinfectants used in Hospitals of Tehran University of Medical
Sciences, Based on their dominant infectious agents. Article
presented in 12th National Conference of Environmental Health
of Iran, Tehran, Iran: Shahid Beheshti University of Medical
Sciences; 2009. Available from: http://www.civilica.com/
Paper-NCEH12-NCEH12_095.html [Last accessed on 2011 Jun 20].
3. Macdonald M, Mullet M, Seshia M. Avery’s neonatology and
management of the newborn. 6th ed. Philadelphia: Lippincott
Williams and Wilkins; 2005.
4. Sondhi V, Gupta G, Patnaik S. Preventing neonatal sepsis:
Evidence-based approach for level 2 and 3 units. J Neonatol
2009;23:22-33.
5. Valles J, Fernandez I, Alcaraz D, Chacon E, Cazorla A, Canals M, et al.
Prospective randomized trial of 3 antiseptic solutions for prevention
of catheter colonization in an intensive care unit for adult patients.
Infect Control Hosp Epidemiol 2008;29:847-53.
6. Ahlqvist M, Bogren A, Hagma S, Nasar I, Nilsson K, Nordin K,
et al. Handling of peripheral intravenous cannulae: Effects of
evidence-based clinical guidelines. J Clin Nurs 2006;15:1354-61.
7. Singh R, Bhandary S, Pun KD. Peripheral intravenous catheter
related phelebitis and its contributing factors among adult
population at Ku Teaching Hospital. Kathmandu Univ Med J (KUMJ)
2008;6:443-7.
8. Balamongkhon B, Thamlikitkul V. Implementation of chlorhexidine
gluconate for central venous catheter site care at siriraj hospital,
Bangkok, Thailand. Am J Infect Control 2007;35:585-8.
9. Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson text
book of pediatrics. 18th ed. Philadelphia: Saunders Elsevier; 2007.
10. Frasca D, Dahyot-Fizelier C, Mimoz O. Prevention of central venous
catheter-related infection in the intensive care unit. Crit Care
2010;14:212.
11. Chaiyakunapruk NM, Veenstra DL, Lispky BA, Saint S. Chlorhexidine
compared with povidone-iodine solution for vascular catheter-site
care: A meta-analysis. Ann Intern Med 2002;136:792-801.
12. Garland JS, Alex CP, Uhing MR, Peterside IE, Rentz A, Harris MC.
Pilot trial to compare tolerance of chlorhexidine gluconate to
povidone-iodine antisepsis for cetral venous catheter placement
inneonates. J Perinatol 2009;29:808-13.
13. O’Rourke E, Runyan D, O’Leary J, Stern J. Contaminated iodophor
in the operating room. Am J Infect Control 2003;31:255-6.
14. Fazeli MR, Sabzechian N, Mahboubi A, Rezayat SM, Samadi N,
Jamalifar H. Pharmacopoeial specifications and effect of dilution
on bactericidal activity of commercially available povidone
iodine solutions in Iran. 22012;22:51-6. (In Persian. English
abstract Available from: http://www.iau-tmuj.ir/browse.php?a_
id=543andsid=1andslc_lang=en). [Last accessed on Nov 17 2013].
15. Jayakumar S, Kanagavalli M, Shameem Banu AS, Renu M, Kalyani M,
Binesh LY. The in Vitro efficacy testing of skin disinfectants against
nosocomial pathogens. J Clin Diagn Res 2011;5:231-5.
16. Fitzpatrick JJ, Kazer MW. Encyclopedia of Nursing Research. 3rd ed.
New York: Springer Publication; 2012.
17. Polit DF, Beck CT. Nursing Research: Generating and Assessing
Evidence for Nursing Practice. 9th ed. Philadelphia: Wolters Kluwer
Health/Lippincott Williams and Wilkins; 2012.
18. Hulley SB. Designing clinical research. 3rd ed. Philadelphia,
Philadelphia: Lippincott Williams and Wilkins; 2007.
19. Mullany LC, Khatry SK, Sherchand JB, LeClerq SC, Darmstadt GL,
Katz J, et al. A randomized controlled trial of the impact of
chlorhexidine skin cleansing on bacterial colonization of
hospital- born infants in Nepal. Pediatr Infect Dis J 2008;27:505-11.
20. Darmstadt GL, Hossain MM, Choi Y, Shirin M, Mullany LC,
Islam M, et al. Safety and Effect of Chlorhexidine Skin Cleansingon Skin Flora of Neonates in Bangladesh. Pediatr Infect Dis J
2007;26:492-5.
21. Veiga DF, Damasceno CA, Veiga Filho J, Silva RV, Cordeiro DL,
Vieira AM, et al. Influence of Povidone-Iodine preoperative showers
on skin colonization in elective plastic surgery procedures. Plast
Reconstr Surg 2008;121:115-8.
22. Kasuda H, Fukuda H, Togashi H, Hotta K, Hirai Y, Hayashi M. Skin
disinfection before epidural catheterization: Comparative study
of povidone-iodine versus chlorhexidine ethanol. Dermatology
2002;204(Suppl 1):42-6.
23. Khera SY, Kostyal DA, Deshmukh N. A comparison of chlorhexidine
and povidone-iodine skin Preparation for surgical operations. Curr
Surg 1999;56:341-3.
24. Suwanpimolkul G, Pongkumpai M, Suankratay C. A randomized
trial of %2 chlorhexidine tincture Compared with 10% aqueous
povidone-iodine for venipuncture site disinfection: Effects on blood
Culture contamination rates. J Infect 2008;56:354-9.
25. Malani A, Trimble K, Parekh V, Chenoweth C, Kaufman S, Saint S.
Review of clinical trials of skin antiseptic agents used to reduce
blood culture contamination. Infect Control Hosp Epidemiol
2007;28:892-5.
26. Parienti JJ, du Cheyron D, Remakers M, Malbruny B, Leclercq R,
Le Coutour X, et al. Alcoholic povidone-iodine to prevent central
venous catheter colonization: A randomized unit-crossover study.
Crit Care Med 2004;32:708-13.
27. 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;33:768-71.
28. 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;34:430-2.
29. Garland JS, Alex CP, Uhing MR, Peterside IE, Rentz A, Harris MC.
Pilot trial to compare tolerance of chlorhexidine gluconate to
povidone-iodine antisepsis for central venous catheter placement
in neonates. J Perinatol 2009;29:808-13.
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