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chlorhexidine vs. providone iodine

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

Has 5 years experience. Specializes in ICU.

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

Specializes in Home health, Ortho.

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

Flightline, BSN, RN

Has 5 years experience. Specializes in ICU.

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.

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

Has 15 years experience. Specializes in LTC, Med/Surg, Peds, ICU, Tele.

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

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

Has 5 years experience. Specializes in ICU.

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

Has 14 years experience. Specializes in PICU/NICU.

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

Has 32 years experience. Specializes in Infusion Nursing, Home Health Infusion.

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

Specializes in Critical Care Nursing.

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.

]

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.

Flightline, BSN, RN

Has 5 years experience. Specializes in ICU.

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.

I guess it's because it's clear and doesn't look like it's there. Of course one could make the same argument for alcohol preps. Oh, and by the way, I notice at this new place I am working that some of the chlorhexidine preps have an orange tint added to them. I don't know if that's an additional germacide or if they added it so it could be seen when applied. I must admit, I do prefer the tinted chlorhexidine preps over povidone iodine.

Magsulfate, BSN, RN

Has 13 years experience. Specializes in ICU.

iluvit shows some very good points in favor of chlorhexidine. Also, one thing to consider is when using iodine you must start from the inside and work your way out as to not spread germs around. In the chorlhexidine literature it says that you can wipe it in a back and forth, round and round, it doesn't matter.. it will kill the germs just as well or better. I was taught that if you just use alchohol, you are just spreading the germs around.

SO, take all of this information, it is very good and informative. Also, look it up! you can list pros and cons of all three of them. The chlorhexidine is by far the best thing we have out right now, to do the job.

highlandlass1592, BSN, RN

Has 13 years experience. Specializes in Critical Care.

I guess it's because it's clear and doesn't look like it's there. Of course one could make the same argument for alcohol preps. Oh, and by the way, I notice at this new place I am working that some of the chlorhexidine preps have an orange tint added to them. I don't know if that's an additional germacide or if they added it so it could be seen when applied. I must admit, I do prefer the tinted chlorhexidine preps over povidone iodine.

The orange tint is for color not extra bactericide or so the rep told us when we were inservcied. Oh my gosh, when we first switched our OR preps, the prep was green tinted. Everyone looked like they were prepped for St. Patrick's day!!!! Nothing like trying to figure out if green extremities are from lack of perfusion or dye!LOL

NotReady4PrimeTime, RN

Has 25 years experience. Specializes in NICU, PICU, PCVICU and peds oncology.

Our bottled Soluprep is red. On the skin it's pink. Some parents are quite upset when they first see it because they think their child has either a rash or a burn. The OR gang will apply Tegaderm right over the pink skin and then the Tegaderm is dyed pink. But I do like that I can see where we've put it.

Don't know if I'd like to have CHG used for foley insertion... would think it would sting like nobody's business! (Based on my experience getting it in paper cuts...)

mama_d, BSN, RN

Has 10 years experience. Specializes in tele, oncology.

My facility has done away with both alcohol swabs and betadine swabs for skin prep. Both the IV start kits and the line dressing change kits come with Chloraprep; we instituted the use of biopatches about six months ago.

Still use betadine swabsticks for Foleys though; I guess they haven't come up with a suitable replacement that can go on peri area yet. I know Hibiclens is contraindicated on peri area, I just looked it up the other day for a patient who straight caths herself and has a raging UTI as a possible alternative to soap and water.

iluvivt, BSN, RN

Has 32 years experience. Specializes in Infusion Nursing, Home Health Infusion.

The CHG persists for at LEAST 6 hours and may last up to 7 days. So basically this is saying you are guaranteed six hours but you may get more

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.

If it's an evidence-based study, not totally sure why you would need opinions.

But as far as the evidence, it's pretty strongly in favor of chlorhexidine.

http://www.ncbi.nlm.nih.gov/pubmed/18407355?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/10610628?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The evidence is similar for the use of chlorhexidine vs iodine-based products in surgical prep as well.

TiredMD - As my original post stated, we are to draw from our own clinical experience. As I explained, I have next to none. We were told to be creative in this section of the project if we didn't have a clinical experience from which to draw.

Just following orders here....

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