@article {Kieranfetalneonatal-2016-312193, author = {Emily A Kieran and Anne O{\textquoteright}Sullivan and Jan Miletin and Anne R Twomey and Susan J Knowles and Colm Patrick Finbarr O{\textquoteright}Donnell}, title = {2\% chlorhexidine{\textendash}70\% isopropyl alcohol versus 10\% povidone{\textendash}iodine for insertion site cleaning before central line insertion in preterm infants: a randomised trial}, elocation-id = {fetalneonatal-2016-312193}, year = {2017}, doi = {10.1136/archdischild-2016-312193}, publisher = {BMJ Publishing Group}, abstract = {Objective To determine whether 2\% chlorhexidine gluconate{\textendash}70\% isopropyl alcohol (CHX{\textendash}IA) is superior to 10\% aqueous povidone{\textendash}iodine (PI) in preventing catheter-related blood stream infection (CR-BSI) when used to clean insertion sites before placing central venous catheters (CVCs) in preterm infants.Design Randomised controlled trial.Setting Two neonatal intensive care units (NICUs).Patients Infants \<31 weeks{\textquoteright} gestation who had a CVC inserted.Interventions Insertion site was cleaned with CHX{\textendash}IA or PI. Caregivers were not masked to group assignment.Main outcome measures Primary outcome was CR-BSI determined by one microbiologist who was masked to group assignment. Secondary outcomes included skin reactions to study solution and thyroid dysfunction.Results We enrolled 304 infants (CHX{\textendash}IA 148 vs PI 156) in whom 815 CVCs (CHX{\textendash}IA 384 vs PI 431) were inserted and remained in situ for 3078 (CHX{\textendash}IA 1465 vs PI 1613) days. We found no differences between the groups in the proportion of infants with CR-BSI (CHX{\textendash}IA 7\% vs PI 5\%, p=0.631), the proportion of CVCs complicated by CR-BSI or the rate of CR-BSI per 1000 catheter days. Skin reaction rates were low (\<1\% CVC insertion episodes) and not different between the groups. More infants in the PI group had raised thyroid-stimulating hormone levels and were treated with thyroxine (CHX{\textendash}IA 0\% vs PI 5\%, p=0.003).Conclusions We did not find a difference in the rate of CR-BSI between preterm infants treated with CHX{\textendash}IA and PI, and more infants treated with PI had thyroid dysfunction. However, our study was not adequately powered to detect a difference in our primary outcome and a larger trial is required to confirm our findings.Trial registration This study was registered with the EU clinical trials register before the first patient was enrolled (Eudract 2011-002962-19). (https://www.clinicaltrialsregister.eu)}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/early/2017/10/25/archdischild-2016-312193}, eprint = {https://fn.bmj.com/content/early/2017/10/25/archdischild-2016-312193.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }