TOPLINE:

Skin disinfection with high-concentration chlorhexidine in isopropyl alcohol reduced the incidence of catheter-related infections compared with skin disinfection with povidone iodine solutions, with lower risks for catheter-related bloodstream infections and catheter-tip colonization.

METHODOLOGY:

• Researchers conducted a systematic review and network meta-analysis of 16 randomized controlled trials to determine which antiseptic strategy — chlorhexidine gluconate or povidone‑iodine — most effectively prevents catheter‑related infections.
• They assessed 7803 patients and 11,985 catheters and performed an exploratory analysis comparing high- and low-concentration chlorhexidine gluconate and alcohol-based and aqueous formulations.
• Primary outcomes were the incidence of catheter-related bloodstream infections; catheter-tip colonization, defined as ≥ 15 colony-forming units (CFUs) using the roll-plate method or ≥ 1000 CFUs per mL using broth dilution; and local infections, defined as purulent drainage at the insertion site and the presence of pain, with or without body temperature exceeding 38 °C.
• The secondary outcomes included adverse events at the skin insertion site.
• Skin disinfection was defined as preparing the skin before insertion of an intravascular catheter, using any method of application (single‑use applicators or multiuse bottles with sterile gauze).

TAKEAWAY:

• The use of alcoholic chlorhexidine as an antiseptic solution was associated with a lower risk for catheter-related bloodstream infections (based on 13 studies) than the use of aqueous povidone-iodine (relative risk [RR], 0.23; 95% CI, 0.16-0.33) or alcoholic povidone-iodine (RR, 0.70; 95% CI, 0.45-1.08).
• In a pooled analysis of 15 studies, the use of alcoholic chlorhexidine was associated with a lower risk for catheter-tip colonization than the use of aqueous povidone-iodine (RR, 0.29; 95% CI, 0.25-0.33) or alcoholic povidone-iodine (RR, 0.42; 95% CI, 0.37-0.48).
• Across three studies, the use of alcoholic chlorhexidine was associated with a lower risk for local infections than the use of aqueous povidone-iodine (RR, 0.24; 95% CI, 0.08-0.70) or alcoholic povidone-iodine (RR, 0.40; 95% CI, 0.23-0.70).
• Ten studies reported fewer catheter‑site adverse events with aqueous vs alcoholic antiseptics. The use of higher concentrations (≥ 1%) of alcoholic chlorhexidine was associated with lower rates of catheter-related bloodstream infections and catheter colonization than the use of lower concentrations.

IN PRACTICE:

“These findings support most international guidelines favoring alcoholic formulations of high concentration alcoholic CHG [chlorhexidine gluconate] over PVI [povidone-iodine] for site disinfection before intravascular catheter insertion,” the authors wrote.

SOURCE:

This study was led by Bertrand Drugeon, MD, Centre Hospitalier Universitaire de Poitiers, Poitiers, France. It was published online on February 12, 2026, in JAMA Network Open.

LIMITATIONS:

The study was limited by clinical and methodologic heterogeneity across settings, including variations in the unit of analysis, antiseptic concentrations, antiseptic formulations, and catheter types and nonstandardized application protocols. Low- and middle-income countries were underrepresented.

DISCLOSURES:

No specific funding source was reported for the study. One author reported attending the bioMérieux Congress, and another author reported receiving personal fees from Siemens, bioMérieux, and Abbott.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.