Comparison of Chlorhexidine-Alcohol and Povidone-Iodine for Skin Antisepsis and the Effect of Increased Blood Volume in Blood Culture
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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 ≥ 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.
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 ≥ 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.
참고문헌 (19)
- Souvenir D, "Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients", J Clin Microbiol, 36, pp.1923~1926 (1998)
- Little JR, "A randomized trial of povidone-iodine compared with iodine tincture for venipuncture site disinfection: effects on rates of blood culture contamination", Am J Med, 107, pp.119~125 (1999)
- Hall KK, "Updated review of blood culture contamination", Clin Microbiol Rev, 19, pp.788~802 (2006)
- Cockerill FR 3rd, "Optimal testing parameters for blood cultures", Clin Infect Dis, 38, pp.1724~1730 (2004)
- Mimoz O, "Chlorhexidine compared with povidone-iodine as skin preparation before blood culture", A randomized, controlled trial. Ann Intern Med, 131, pp.834~837 (1999)
- Eskira S, "Reduction of blood culture contamination rate by an educational intervention", Clin Microbiol Infect, 12, pp.818~ (2006)
- Riedel S, "Blood cultures: key elements for best practices and future directions", J Infect Chemother, 16, pp.301~316 (2010)
- Li J, "Effects of volume and periodicity on blood cultures", J Clin Microbiol, 32, pp.2829~2831 (1994)
- CLSI, "Principles and procedures for blood cultures; approved guideline. CLSI document M47-A", Clinical and Laboratory Standards Institute, ~ (2007)
- Bouza E, "Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections?", J Clin Microbiol, 45, pp.2765~2769 (2007)
- Towns ML, "Guidelines on blood cultures", J Microbiol Immunol Infect, 43, pp.347~349 (2010)
- 신정환, "Comprehensive Analysis of Blood Culture Performed at Nine University Hospitals in Korea", Annals of Laboratory Medicine, 31(2), pp.101~106 (2011), 대한진단검사의학회
- Darby JM, "Utilization and diagnostic yield of blood cultures in a surgical intensive care unit", Crit Care Med, 25, pp.989~994 (1997)
- Weinstein MP, "Blood culture contamination: persisting problems and partial progress", J Clin Microbiol, 41, pp.2275~2278 (2003)
- Malani A, "Review of clinical trials of skin antiseptic agents used to reduce blood culture contamination", Infect Control Hosp Epidemiol, 28, pp.892~895 (2007)
- Schifman RB, "Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients", Arch Pathol Lab Med, 122, pp.216~221 (1998)
- Shahar E, "Contamination of blood cultures during venepuncture: fact or myth?", Postgrad Med J, 66, pp.1053~1058 (1990)
- Baron EJ, "Coordinating" (2005), ASM Press
- 신정환, "Nationwide Survey of Blood Culture Performance Regarding Skin Disinfection, Blood Collection and Laboratory Procedure", Annals of Clinical Microbiology, 14(3), pp.91~96 (2011), 대한임상미생물학회