Comparison of total aerobic count before and after application of different antiseptic solutions prior to venipuncture and its correlation to developing phlebitis, in children admitted at a tertiary hospital in Quezon City

Mary Antonette   C. Madrid,; Michael  M. Resurreccion,; Melady  D. Imperial,

Comparison of total aerobic count before and after application of different antiseptic solutions prior to venipuncture and its correlation to developing phlebitis, in children admitted at a tertiary hospital in Quezon City

Melady D. Imperial | Michael M. Resurreccion | Mary Antonette C. Madrid

Abstract:

OBJECTIVE: To compare the effect on Total Aerobic Count (TAC) of application of Isopropyl alcohol, Chlorhexidine, and povidone iodine plus alcohol prior to venipuncture and development of phlebitis in children admitted at a tertiary hospital. METHODS: A prospective randomized clinical trial in a tertiary hospital in Quezon City. A total of 129 patients one-year old and above with physician orders for IV insertion and extractions. Pre and post swabbing of the venipuncture site was done and placed on a blood agar plate. The three antiseptic solutions were applied over the venipuncture site and swabbed and placed on the agar plate. The primary outcome measure was the TAC in each blood agar of the tested antiseptic solution and correlation to developing phlebitis. RESULTS: The CFU/mL after disinfection was significantly different between groups, with the lowest CFU/mL observed among patients disinfected with Chlorohexidine. Phlebitis was only noted in the alcohol group. No reactions were observed from patients who were disinfected with povidone iodine and chlorohexidine. CONCLUSIONS: Single application of Chlorhexidine is the optimal method to be used as antisepsis prior to procedures like venipuncture. However, the use of povidone iodine plus 70% isopropyl alcohol also has comparable effect to Chlorhexidine.

References:

Alexandrou E, Baruel GR, Carr P, et al. International prevalence of the use of peripheral intravenous catheters. J Hosp Med. 2015;00(00).
Oliveira A, et al. Incidence of phlebitis in patients with peripheral intravenous catheters: The influence of some risk factors. Aust J Adv Nurs. 2010;30(2).
Saini R, Agnihotri M, Gupta A, Walia I. Epidemiology of infiltration and phlebitis. Nurs Midwifery Res J. 2011;7(1).
O’Grady NP, Alexander M, Burns LA, et al.; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. 2011.
Maiwald M, Chan ESY. The forgotten role of alcohol: A systematic review and meta-analysis of the clinical efficacy and perceived role of chlorhexidine in skin antisepsis. PLoS One. 2012;7(9):e4427.
Pratt RJ, Pellowe C, Loveday HP, et al. The EPIC project: Developing national evidence-based guidelines for preventing healthcare-associated infections. Phase I. J Hosp Infect. 2001;47(Suppl):S3–S82.
Centers for Disease Control and Prevention. CDC’s 7 healthcare safety challenges. Atlanta, GA: US Department of Health and Human Services; 2001.
Saini R, Agnihotri M, Gupta A, Walia I. Epidemiology of infiltration and phlebitis. Nurs Midwifery Res J. 2011;7(1).
Oliveira A, et al. Incidence of phlebitis in patients with peripheral intravenous catheters: The influence of some risk factors. Aust J Adv Nurs. 2010;30(2).
Webster J, McGrail M, Marsh N, Wallis MC, Ray-Barruel G, Rickard CM. Postinfusion phlebitis: Incidence and risk factors. Nurs Res Pract. 2015;2015:691934.
Kiyoyama T, Tokuda Y, Shiiki S, Hachiman T, Shimasaki T, Endo K. Isopropyl alcohol compared with isopropyl alcohol plus povidone-iodine as skin preparation for prevention of blood culture contamination. 2008.
Mimoz O, Villeminey S, Ragot S, Dahyot-Fizelier C, Laksiri L, Petitpas F, Debaene B. Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med. 2007.
Kumar JK, Reddy HK, Gunashakaran V, Ramesh Y, Kalyan Babu P, Narasimha PN, Venkatewarulu A, Lakshmikanth Reddy P. Application of broad-spectrum antiseptic povidone iodine: A review. J Pharm Sci Technol. 2009;1(2):48–58.
Mimoz O, Villeminey S, Ragot S, Dahyot-Fizelier C, Laksiri L, Petitpas F, Debaene B. Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med. 2007;167(19):2066–2072.
Barenfanger J, Drake C, Lawhorn J, Verhulst SJ. Comparison of chlorhexidine and tincture of iodine for skin antisepsis in preparation for blood sample collection. 2004.
Maki DG. Infection caused by intravascular devices: Pathogenesis and strategies for prevention. In: Improving Catheter Site Care. London: Royal Society of Medicine; 1991.
Reichel M, Heisig P, Kohlmann T, Kampf G. Alcohols for skin antisepsis at clinically relevant skin sites. 2009.
Mahmoud M, Asaad A, Qureshi M. Hand rubbing and scrubbing in relation to microbial count among surgical team members in a Saudi hospital. Life Sci J. 2013;10(3).
Nagpal P, Khera GK, Kumar Y. A study to assess the clinical pattern of phlebitis among children admitted in a selected hospital in Ambala, Haryana. Nurs Midwifery Res J. 2015;11(2).