chlorhexidine vs. providone iodine

[K os]

Hi All -

I need your opinion. A group of us is working on a project for our BSN Nursing Research class. It is an evidence based practice paper about the use of chlorhexidine vs povidone iodine for disinfecting the skin prior to venipuncture. We have very limited clinical experience on which to draw (Med/Surg I and psych) so we thought you might share with us your experience.

Do you have a choice on which you use?

If so, which do you prefer and why?

Does the hospital make the choice and if so which one is recommended?

My part of the project is to write about "the current situation in my clinical area." As this is obviously not a true research study, I am hoping to gather some real life opinons from you all.

Thanks for your time and expertise!

[Flightline, BSN, RN]

I have to ask: Why not just write about "the current situation in your clinical area"? But I will give you my opinion for what it's worth. I like povidone iodine. For one, it darkens the skin a little which can provide some contrast for seeing veins. I use it at home for minor injuries and it flat out works. It's been used forever everywhere and it flat out works. My clinical area uses chlorhexidine, but we also have access to iodine. I typically grab whatever is there. I started an IV on a guy today and used chlorhexidine. But if I were starting my own IV, I'd want povidone. I trust it.

[dmdrn73]

I've always used alcohol swabs. I know for Central and PICC line dressing changes I much prefer the Chlorhexidine.

[Flightline, BSN, RN]

I've always used alcohol swabs. I know for Central and PICC line dressing changes I much prefer the Chlorhexidine.

I agree. I like alcohol swabs, too. And I like they way they wet the skin and make it easier to feel for a vein.

[K os]

Flightline - to answer your question about "my clinical area." At the moment, I don't have one. I had Med/Surg last summer and in my most recent clinical in psych, we were not authorized to pass meds. I don't start my OB clinical until January.

[FireStarterRN, BSN, RN]

A lot of places have pretty much done away with providine because of allergies.

[medicinemanrn]

The studies that are out there now show that the cleaning of the skin happens during the drying process. Povidone iodine dries much more slowly than chlorhexidine. A recent study showed that chlorhexidine decreased CRBSI (catheter related blood stream infections) by 50% vs. 2 % for povidone iodine.

I, too, liked the way povidone iodine made the blood vessels easier to identify. But our facility has ceased using povidone iodine for everything except a few, specific surgeons orders.

Sometimes we embrace change, sometimes we go forward kicking and screaming all the way. Either way, change is inevitable.

[Flightline, BSN, RN]

The studies that are out there now show that the cleaning of the skin happens during the drying process. Povidone iodine dries much more slowly than chlorhexidine. A recent study showed that chlorhexidine decreased CRBSI (catheter related blood stream infections) by 50% vs. 2 % for povidone iodine.

I, too, liked the way povidone iodine made the blood vessels easier to identify. But our facility has ceased using povidone iodine for everything except a few, specific surgeons orders.

Sometimes we embrace change, sometimes we go forward kicking and screaming all the way. Either way, change is inevitable.

Yeah, well studies can show just about anything we want them to show, but be that as it may, what do you use for folies?

[PICNICRN, BSN, RN]

We use only Chloraprep now days... no more betadine. Personally, I like it. Betadine needs to be "washed off" pretty quickly on the small kiddos, it can cause some bad skin irritation. I think the only thing we still used Betadine for is LPs.

[iluvivt, BSN, RN]

The evidence is certainly out there that clearly proves Chlorhexadine Gluconate (CHG) is far superior as a skin prep agent than povidone iodine. In some studies it has been proven if used prior to CVC insertion it can reduce bloodstream infection by 84% and the use of the Chlorhexadine patch (as in a Biopatch or the new gel on 3Ms Tegaderm product) can reduce catheter -related bloodstream infection by 60 %. Those are huge numbers!!!!!!

Also in 2002 the CDC recommended the use of CHG as their first choice for venipuncture site preparation.Since there are allergy issues with some people they continue to recommend povidone iodine and tincture of iodine as additional options. The CDC also recommends the CHG for surgical site preparation as their first choice and also as a prep the night before surgery.

These are some of the reasons it is so SUPERIOR.........even though Betadine and tincture of iodine and CHG kill the same bacteria and fungus the CHG persists on the skin for SIX long hours when used properly.....povidone iodine on the other hand just works while you are using it (2 minutes). So as you can see a huge difference.

It is crucial to allow the CHG to air dry thoroughly before performing the venipunture or procedure........the betadine needs to be on the skin 2 minutes and must also be air dried.....you should never use betadine and then apply alcohol over the with the CHG as their first choice d/t its persistent activity.

Just b/c betadine has been around forever does not mean it is the best b/c clearly it has overwhelmingly been proven that the CHG is so much better.

[chani]

I would concur with iluvit.

See this meta analysis

]

Chaiyakunapruk, N., D. L. Veenstra, et al. (2002). "Chlorhexidine Compared with Povidone-Iodine Solution

for Vascular Catheter–Site Care: A Meta-Analysis." Annals of Internal Medicine ]136]: 792-801.

]

[meandragonbrett]

T

even though Betadine and tincture of iodine and CHG kill the same bacteria and fungus the CHG persists on the skin for SIX long hours when used properly.....povidone iodine on the other hand just works while you are using it (2 minutes). So as you can see a huge difference.

Actually, the Chloraprep solution has antimicrobial activity for 48 hours vs. 2 hours for free iodine.