Skin antiseptics for blood culture collection

[Matthias.Maiwald@KKH.COM.SG Subject: Skin antiseptics for blood culture collection MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Message-ID:]

Dear Group,

I would like to draw your attention to a small letter to the editor that we
just published in ICHE:

http://www.journals.uchicago.edu/doi/abs/10.1086/656561

The original paper published a study of two skin antiseptics before blood
culture collection and the impact in terms of blood culture contamination
rates.

The study describes itself as a trial of “chlorhexidine gluconate versus
povidone-iodine”, and the contamination rate is significantly lower in the
“chlorhexidine” group. However, the antiseptics used were 70% isopropanol
plus 3.15% chlorhexidine versus aqueous povidone-iodine. In the text, the
effect of lowering BC contamination rates is solely attributed to
chlorhexidine. For reasons explained in our letter, there are very solid
data in the literature that in this setting not the chlorhexidine but the
alcohol is the key component in the disinfection process.

This is an interesting misconception about chlorhexidine that I have seen
previously in the US-based ClinMicroNet group and in the US literature. I
am not sure why.

Interestingly, the original authors respond by saying that it is not
conclusive that the alcohol is the main component, however all 4 papers
cited by them show either significant superiority or equivalence of
alcohol-containing versus aqueous skin antiseptics.

Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 1389
Fax +65 6394 1387

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