ReviewSkin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis
Introduction
Venous punctures are common hospital procedures and they can be used to collect blood for microbiological culture. Blood cultures are essential to detect bacteraemia and they are useful for therapeutic decisions. However, a false-positive blood culture due to contamination (BCC) by micro-organisms from places other than blood is a challenging problem for the physician as it can lead to misinterpretation and inappropriate treatment. It can contribute to considerable financial expenses, since additional tests can be done and unnecessary or inadequate antibiotics are likely to be administered.1, 2, 3 The dimension of the problem is not well determined since it can range from 0.6% to 6%.4 Micro-organisms that contaminate cultures can come from patient skin, healthcare personnel skin, contaminated recipients, or laboratory procedures. Patients’ skin disinfection decreases the number of blood culture false positives. Alcohol, chlorhexidine and iodine products are commonly used for this purpose.
The aim of this meta-analysis was to determine which skin antiseptic is the best to decrease blood culture contaminations.
Section snippets
Searching
A searching strategy was developed using CENTRAL (Cochrane Library issue April 2010), MEDLINE, EMBASE and mRCT databases without language limitations, in June 2010.
Search was made using a filter for randomised controlled trials (RCTs) with the following keywords: ‘antiseptic’, ‘chlorhexidine’, ‘iodine’, ‘povidone’, ‘alcohol’, ‘skin’ and ‘blood culture’. Boolean operators AND and OR were used to combine the terms. NOT operator was used to exclude surgical studies and catheter disinfection trials.
Results
Applied search filters resulted in 40 references identified initially in the four databases. Fourteen duplicated records were removed resulting in 26 studies. After title and abstract evaluation, 17 studies were excluded because they did not analyse skin antiseptics and/or blood culture contamination. The remaining nine studies were evaluated for possible inclusion in meta-analysis. Three trials were excluded after full-text assessment because they did not test skin antiseptics for prevention
Discussion
Our systematic review analyses a long-debated issue: which skin antiseptic is superior in terms of fewer false-positive cultures?
There were some differences in the definition of blood culture contamination between studies (Table I). In future clinical trials in this area, investigators should take into account a single definition of BCC, as the Q-Tracks cohort study did for 356 clinical laboratories.12
Twenty percent of skin bacteria are in the deeper layers, untouched by antiseptics.13 Blood
Conclusions
Alcohol is not inferior to iodinated solutions. The association of alcohol and povidone-iodine does not seem to be useful. The association of alcohol with iodine tincture is more likely to be useful.
Alcoholic chlorhexidine solutions showed statistically significant reduction in blood culture false-positives compared with aqueous povidone-iodine, and a non-significant but potentially clinically relevant reduction of outcome compared with alcoholic iodine.
Overall, alcoholic products appear to be
Conflict of interest statement
None declared.
Funding sources
None.
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