Chlorhexidine 2% and alcohol for skin disinfection was more efficacious in protecting against peripheral venous catheter-related infection compared with 5% povidone iodine and alcohol, according to study results published in The Lancet Infectious Diseases.

In this open-label, randomized, controlled trial (CLEAN 3; Identifier: NCT03757143) study, patients (N=995) who received a catheter at the emergency department were randomized in a 1:1:1:1 ratio to receive 2% chlorhexidine with alcohol or 5% povidone iodine with alcohol and either Nexiva (Becton Dickinson) single-port catheter (innovation) or Insyte Autoguard Blood Control Winged catheter (standard; Becton Dickinson). Catheter-related infections or complications were assessed for 48 hours following catheter removal.

Patients had a median age of 76 years (interquartile range, 62-86), 51% were men, and 67% had 1 or more chronic comorbidities. In total, 86% of catheters were cultured. Of the patients, 76% were assessed at 24 hours and 69% were assessed at 48 hours.

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Local infections were observed among 6 patients and colonized catheters among 74. Stratified by antiseptic, the chlorhexidine recipients had fewer local infections (0% vs 1%) or colonization events (1% vs 17%) than with the iodine recipients, respectively (hazards ratio, 0.08; 95% CI, 0.02-0.18).

Failures occurred among 41% of catheters. Stratified by catheter type, patients who received an innovation device had fewer failure events (35% vs 48%; hazards ratio, 0.52; 95% CI, 0.35-0.72), occlusions (4% vs 9%), and dislodgments (14% vs 19%) compared with the patients in the standard device cohort, respectively. Device type had no effect on infiltration, phlebitis, or local infections.

Rates of catheter-related infectious complications were decreased among the patients in the chlorhexidine cohort (absolute difference, -12.8%; 95% CI, -16.1% to -9.5%) and rates of catheter failure were decreased among the patients in the innovation device group (absolute difference, -11.4%; 95% CI, -17.5% to -5.3%).

This study was limited by not including a cost-benefit analysis. It remains unclear whether the decreased catheter failure rate justifies the use of the innovative device.

The study authors concluded antiseptic of 2% alcoholic chlorhexidine was superior at protecting against peripheral venous catheter-related infections and fewer catheter failures were observed with a single-port catheter.

Disclosure: Multiple study authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.


Guenezan J, Marjanovic N, Drugeon B, et al; CLEAN-3 trial investigators. Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial. Lancet Infect Dis. Published online February 1, 2021. doi:10.1016/S1473-3099(20)30738-6