Alcoholic Chlorhexidine Superior Antiseptic for Peripheral Venous Catheter Placement

This picture taken on June 7, 2018 in the production unit of stents and catheters of the BALT company in Montmorency shows catheters. – Since it was established in 1977, BALT has worked with neurovascular surgeons to treat complex life-threatening conditions such as strokes, aneurysms and arteriovenous malformations. A pioneer in its field, BALT designs, manufactures and distributes the ‘Interventional Neuro Radiology (INR) devices such as catheters, stents and coils that are essential in treating such conditions. BALT is one of the leading pure play MedTech companies in Europe, and is a supplier to all major French and international hospitals practicing neuroradiology surgery. (Photo by GERARD JULIEN / AFP) (Photo by GERARD JULIEN/AFP via Getty Images)
Researchers aimed to show that disinfection with chlorhexidine 2% with alcohol was superior to povidone iodine 5% with alcohol in preventing infectious complications.

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.

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