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.
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.
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.
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
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...)
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.
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.
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.
Flightline, BSN, RN
213 Posts
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.