O emprego da iodopovidona alcoolizada em detrimento da iodopovidona simples em solução mostrou eficácia acrescida comprovada. Nos estudos demonstram que o uso de soluções à base de Clorexidina podem reduzir as taxas de infecção em 50%:
http://www.medscape.com/viewarticle/564782
October 25, 2007 — Chlorhexidine-based solutions should be considered as a replacement for povidone-iodine formulations, including those that are alcohol based, in efforts to prevent central venous catheter–related infection, according to the results of a study reported in the October 22 issue of the Archives of Internal Medicine.
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Culture results were evaluable in 481 (89.4%) of catheters studied. Compared with use of povidone-iodine, the chlorhexidine-based solution was associated with a 50% reduction in the incidence of catheter colonization (11.6% vs 22.2%; P =.002; incidence density, 9.7 vs 18.3 per 1000 catheter-days). There was also a statistically nonsignificant trend toward lower rates of catheter-related bloodstream infection (1.7% vs 4.2%; P =. 09; incidence density, 1.4 vs 3.4 per 1000 catheter-days).
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"Our results demonstrate that the use of a chlorhexidine-based solution rather than povidone-iodine is likely to result in decreased catheter colonization," the study authors conclude. "Given the extent of the benefit and the absence of incremental cost, chlorhexidine-based solutions should be considered as a replacement for povidone-iodine (including alcohol-based formulations) in efforts to prevent catheter-related infection."
Não há bela sem senão, dado que o aumento da eficácia acompanha o maior risco de desenvolver reacções adversas imediatas com o emprego da clorexidina, havendo casos de anafilaxia descritos na literatura (muito raros).
Uma vista de olhos pelo CDC, constatei com alguma estupefacção, que é quase do "senso comum" a eficácia da clorexidina comparativamente à iodopovidona, e várias são as publicações nessa matéria. Irão as nossas comissões de infecção basear-se nestes resultados e actualizar os procedimentos normativos, ou teremos que continuar a esperar por mais estudos?