To compare the efficacy of two commercially available, alcohol-based
antiseptic solutions for preparation and care of
central venous catheter (CVC) insertion sites, with and without
octenidine dihydrochloride, a double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different skin disinfection regimens at the insertion site: 0.1%
octenidine with 30%
1-propanol and 45%
2-propanol, and as control 74%
ethanol with 10%
2-propanol. Endpoints were (i) skin colonization at the insertion site; (ii) positive culture from the
catheter tip (> or = 15 CFU); and (iii) occurrence of CVC-associated
bloodstream infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly reduced by
octenidine treatment (relative difference
octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p <0.0001). Positive culture of the
catheter tip was significantly less frequent in the
octenidine group (7.9%) than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with
octenidine had a non-significant reduction in
catheter-associated
bloodstream infections (4.1% vs. 8.3%; OR = 0.44; 95%CI: 0.18-1.08, p 0.081). Side effects were similar in both groups. This randomized controlled trial supports the results of two observational studies demonstrating
octenidine in alcoholic
solution to be a better option than alcohol alone for the prevention of CVC-associated
infections.