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Chlorhexidine vs. Iodine Solution - Adverse Reactions Comparison

Introduction

Adulterated blood cultures result in unnecessary costs and meager patient care, while promoting the deployment of pointless antibiotics. In the US alone, studies have shown that physicians insert at least 5 million central venous catheters annually. Regrettably, the deployment of central venous catheters is linked to adversative events, which are dangerous and expensive to treat. Bloodstream infections related to catheter insertions have been reported in about 3-8% of catheters. In addition, these infections are the major cause of nosocomial bacteremia in Intensive Care Units (ICUs) with at least 80000 cases yearly. The financial cost of these cases translates to about USD 2.3billion. Majority of health care practitioners is aware of the catheter-related adversarial incidences, such as bloodstream contamination, and perceive them as one of the challenges of the health care system.

 

With the challenge of blood contamination at hand, health care institutions and researchers have set out to investigate the potential remedy. Most of these studies have frequently settled on chlorhexidine or iodine solution. Unfortunately, these studies have been engaged in epic battles by trying to oppose the suitability of each solution in relation to patient safety and cultural and legal issues. In most of the studies, the ways of making iodine and chlorhexidine vary significantly. Against this background, current paper compares chlorhexidine and iodine solutions.

Patient Safety

Chaiyakunapruk, Veenstra, Lipsky, and Saint (2002) set out to investigate the variations between chlorhexidine and iodine solutions in terms of catheter related bloodstream contamination and catheter colonization. In their meta-analysis, Chaiyakunapruk et al. (2002) found out that the likelihood of catheter-associated bloodstream contamination was significantly lower for individuals subjected to chlorhexidine than for individuals subjected to iodine. Individuals subjected to chlorhexidine exhibited lower rates of colonization than those subjected to iodine solution. Chaiyakunapruk et al. (2002) cited that the likelihood ratio for catheter colonization in case of vascular chlorhexidine in comparison with iodine was 0.49. The study therefore argued that the summary risk ratio for blood contamination associated with vascular catheters was 0.49, which indicated a considerably decreased risk in patients subjected to chlorhexidine solution (Chaiyakunapruk et al., 2002).

Noorani, Rabey, Walsh, and Davies (2010) emphasized that the utilization of chlorhexidine solution for the care of catheter sites is mainly more efficient than the use of iodine solution for preventing infections associated with vascular catheter. The decrease of risk of catheter-associated contamination of the bloodstream in Chaiyakunapruk et al. (2002) main analysis indicated that chlorhexidine decreased the bloodstream infection by about 50%. In Chaiyakunapruk et al. (2002) meta-analysis, the decease remained statistically significant even when only the central venous catheters were applied. Chaiyakunapruk et al. (2002) and Noorani et al. (2010) highlighted that the implications of such a decrease are crucial because patients requiring central venous catheters are essentially at a high risk of costly complication. The scale of risk decrease in the analyses of the subgroups was similar to that of the main analysis. Chaiyakunapruk et al. (2002) claimed to have found a significant variation in main subgroup to low incidence of clinical events.

Darouiche et al. (2010) also set out to conduct a randomized investigation that compared chlorhexidine and iodine solutions. In their study, Darouiche et al. (2010) randomly assigned adults undertaking clean-contaminated surgery in different hospitals to preoperative skin preparation with either iodine solution or chlorhexidine solution. Darouiche et al.’s (2010) findings concurred with those of Chaiyakunapruk et al. (2002). The research revealed that the rate of surgical-site infection was considerably lower in individuals subjected to chlorhexidine solution than in individuals subjected to iodine solution. According to Darouiche et al. (2010), the comparative risk of surgical site infection (SSI) among patients whose skin was preoperatively cleansed with chlorhexidine solution versus iodine was 0.59. Likewise, Darouiche et al. (2010) found out that the use of chlorhexidine was associated with substantially fewer superficial incisional infections, and deep incision infections. Nevertheless, Darouiche et al.’s (2010) study found no considerable variations between individuals subjected to chlorhexidine and those subjected to iodine solution in the incidence of organ space infection.

Blood Culture

Another randomized trial by Mimoz et al. (2007) also attempted to compare chlorhexidine and iodine solutions in terms of bacteremia. Blood culture refers to a test aimed at finding infection in the blood. Blood often does not contain any fungi or bacteria in it. Bacterial infections, referred to as bacteremia, can be identified through blood culture. Chlorhexidine and iodine solutions differ in the likelihood of introducing bacterial infection into the bloodstream.

Mimoz et al. (2007) found out that catheters allocated to povidone-iodine were more likely to be infected than those assigned to chlorhexidine. Out of the 242 catheters allocated to chlorhexidine solution, only 28 were infected compared to 53 out of 239 catheters allocated to iodine. Mimoz et al. (2007) and Noorani et al. (2010) argued that variations were considerable only for catheters inserted in the subclavian vein, but not in the jugular vein. Catheters used with chlorhexidine were substantially less often colonized with gram-positive cocci, gram-negative bacilli or coagulase-negative staphylococci. However, those assigned to iodine solution were more often colonized. According to Mimoz et al. (2007), the colonization rates of catheters with Staphylococcus aureus did not vary considerably between groups.

Again, this study revealed the superiority of chlorhexidine in dealing with catheter colonization. According to Mimoz et al. (2007), this superiority might have various possible explanations. Firstly, irrespective of the ostensible low chlorhexidine amount, its concentration of 2500 microgram per milliliter is fifty times higher than the minimum inhibitory concentration of virtually all nosocomial bacteria and yeasts (Mimoz et al., 2007). In addition, the concentration of chlorhexidine, coupled with the combination of benzalkonium chloride and benzyl alcohol, synergistically prevented almost all gram-negative and gram-positive bacteria and yeasts. The second explanation related to the superiority of chlorhexidine is that blood serum and other biomaterials rich in protein have deactivating microbicidal impact of iodine solution (Mimoz et al., 2007). However, these biomaterials, coupled with blood serum, cannot deactivate the microbicidal impact of chlorhexidine. Thirdly, the residual impact of iodine solution is minimal, whereas that of chlorhexidine is prolonged. In fact, the residual impact of chlorhexidine has been defined as the long-term antimicrobial suppressive activity (Mimoz et al., 2007).

Legal Issues

Both iodine solution and chlorhexidine can be purchased over the counter. The government classifies them as OTC drugs. However, iodine solutions purchased over the counter are intended for topical application for the prevention and treatment of wound infections. Drugs containing iodine solutions are often used as first aid for minor cuts, burns, blisters or abrasions, but not for surgery at home. The recent positions taken by federal agencies, Food and Drug Administration and the Agency for Health Care Policy and Research (AHCPR) have repercussions on the use of iodine purchased over the counter (Tamma, Aucott, & Milstone, 2010). According to Tamma et al. (2010), the Food and Drugs Agency approved povidone iodine for utilization in nonprescription first-aid antiseptic products. This position allows drug manufacturers to incorporate iodine solutions in their first-aid products. According to Tamma et al. (2010), the term first aid should imply that iodine can only be utilized for short-term treatment, about seven days, in case of comparatively acute and superficial wound.

Government regulations do not endorse the use of chlorhexidine solution for curing infants aged less than two months. According to Tamma et al. (2010), the deployment of chlorhexidine in neonatal intensive care units (NICUs) is sophisticated due to its capacity to decrease healthcare-related infection. Consequently, the national infection prevention guidelines, including the Society for Healthcare Epidemiology of America Compendium, do not support the use of chlorhexidine (Tamma et al., 2010). Whereas the US Food and Drug Administration has outlined the utilization of chlorhexidine as part of the multidisciplinary approach to enhance patient outcomes and decrease costs of healthcare, it does not approve the use of chlorhexidine for curing infants aged 2 months and below (Tamma et al., 2010). Concerns related to skin breakdown were the most popular concerns of government regulations against the use of chlorhexidine.

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Conclusion

This paper has compared chlorhexidine and iodine solutions in relation to legal issues, patient safety, and blood culture. In terms of legal issues, both chlorhexidine and iodine products can be purchased over the counter. However, law enforcement agencies exercise a lot of restrictions on the use of chlorhexidine for curing infants aged 2 months and less in neonatal intensive care units. There seems to be no such restrictions related to iodine, though it is assumed that the restriction is also applicable. In terms of patient safety, most of the studies linked chlorhexidine to reduced likelihood of catheter colonization. As a result, iodine solution has been associated with high likelihood of catheter colonization, which compromises the safety of the patient. This research affirmed that chlorhexidine is safer than iodine solution. In terms of blood culture, chlorhexidine is substantially less often linked to gram-positive cocci, gram-negative bacilli or coagulase-negative staphylococci compared to iodine solution.

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