Blood Culture Contamination Rates after Skin Antisepsis with Chlorhexidine Gluconate versus Povidone-Iodine in a Pediatric Emergency Department

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Abstract
Objective.: To determine blood culture contamination rates after skin antisepsis with Chlorhexidine, compared with povidone-iodine.Design.: Retrospective, quasi-experimental study.Setting.: Emergency department of a tertiary care children's hospital.Patients.: Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008. Control patients were children younger than 2 months with peripheral blood culture results.Methods.: Blood culture contamination rates were compared using segmented regression analysis of time-series data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 2-36 months during the 26-month postintervention period, in which 3% Chlorhexidine gluconate was used; and (3) patients younger than 2 months not exposed to the Chlorhexidine intervention (ie, the control group).Results.: Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group, 4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months, the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures (P< .05) after implementation of Chlorhexidine. This decrease of 7.62 contaminated cultures per 1,000 cultures (95% confidence interval, —0.781 to —15.16) represented a 30% relative decrease from the preintervention period and was sustained over the entire postintervention period. No change in contamination rate was observed in the control group (P= .337).Conclusion.: Skin antisepsis with Chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.

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