***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To determine the effect of routine intravenous ( IV ) administration set changes on  central venous catheter ( CVC ) colonization and catheter-related bacteremia .  DESIGN Prospect i ve , r and omized , controlled trial . SETTING Eighteen-bed intensive care unit ( ICU ) in a large metropolitan hospital . PARTICIPANTS Two hundred fifty-one patients with 404 chlorhexidine gluconate and silver sulfadiazine-coated multi-lumen CVCs .  INTERVENTIONS CVCs inserted in the ICU and in situ on day 4 were r and omized to have their IV administration sets changed on day 4 ( n = 203 ) or not at all ( n = 201 ) . Use of fluid containers and blood product administration sets was limited to 24 hours . CVCs were removed when not required , infection was suspected , or in place on day 7 . Catheter cultures were performed on removal by blinded laboratory staff . Catheter-related bacteremia was diagnosed by a blinded intensivist using strict definitions . Data were collected regarding catheter duration , site , Acute Physiology and Chronic Health Evaluation ( APACHE ) II score , patient age , diagnosis , hyperglycemia , hypoalbuminemia , immune status , number of fluid containers and IV injections , and administration of propofol , blood , total parenteral nutrition , or lipid infusion . RESULTS There were 10 colonized CVCs in the group receiving a set change and 19 in the group not receiving one . This difference was not statistically significant on Kaplan-Meier survival analysis . There were 3 cases of catheter-related bacteremia per group . Logistic regression found that burns diagnosis and increased ICU stay significantly predicted colonization . CONCLUSION IV administration sets can be used for 7 days in patients with short-term , antiseptic-coated CVCs In a prospect i ve study , 218 cardiothoracic patients , in whom ' Abbocath-T ' cannulae had been inserted preoperatively into the internal jugular vein , were r and omized to receive skin preparation of the insertion site with tincture of iodine ( 108 controls ) or tincture of iodine followed by application of sterile 2 % calcium mupirocin ointment  ( 110 test patients ) . Cannulae were usually removed within 48 h of the operation . Patients receiving mupirocin  were less likely to develop significant colonization of one or more of their cannulae as judged by Maki 's criterion of a yield of greater than 15 colony forming units ( cfu ) from a cannula segment rolled on an agar plate ( 17 % of mupirocin treated patients compared with 54 % of the controls , P less than 0.001 ) . Coagulase-negative staphylococci , micrococci , or both , were the commonest isolates and were cultured from 70 % of the 186 control cannulae compared with 24 % of 172 cannulae inserted through mupirocin-treated skin ( P less than 0.001 ) . A count of more than 15 cfu was found on the tips of 25 % control cannulae compared with 5 % of the cannulae from mupirocin-treated patients , an effect which was independent of in-situ time ( P less than 0.001 ) . For cannulae with colonized tips , the same species was isolated from the skin of the insertion site in 67 % , from the exterior of the hub in 61 % and from the lumen in only 15 % . There were no side effects attributed to mupirocin or superinfection with resistant organisms . We conclude that in cardiothoracic patients the application of mupirocin after st and ard skin preparation with tincture of iodine significantly reduces the colonization of central venous cannulae by organisms derived from the skin insertion site The objective of this study was to assess the risk of bacteremia , estimate the cost and evaluate the quality of life by using a transparent dressing ( TD ) versus ( vs ) a dry gauze ( DG ) on the exit site of long term central I.V. catheters ( LTCC ) of hemodialysis patients . This 6-months preliminary study was conducted on 58 patients ( pts ) r and omized to receive DG replaced 3 times/week ( 29 pts ) or TD replaced every 7 days ( 29 pts ) .  Data on patients , conditions of the exit site , local infection , bacteremia , quality of life and cost related to each type of dressing were collected . Two pts in the DG group experienced bacteremia related to their LTCC vs 1 pt in the group TD . A total of 7 ( DG ) vs 13 ( TD ) pts experienced skin condition changes at the catheter exit site . Some skin reactions , erythema and pruritus , did occur initially in the group TD and was due in part to insufficient drying time of the skin preparation solution . The estimated individual , weekly costs for using the DG was $ 7.60 vs $ 4.72 Canadian dollars for the TD . The SF-36 ™ scores did not show a significant difference between the 2 groups during the study ( 3.8 ( PCS ) , 6.4 ( MCS ) at study end ) . Although this study was statistically underpowered , it suggests that the incidence of bacteremia was not increased with the use of a TD . Moreover , the use of a TD allowed fewer dressing changes , lowered total treatment costs , with no observed unfavorable impact on the quality of life and without significant local complications of the exit site . Based on the positive results observed in this pilot study , further study is warranted to examine the cost effectiveness of long-term use of TD dressings on dialysis catheter exit sites BACKGROUND Intravascular-catheter-related infections are frequent life-threatening events in health care , but incidence can be decreased by improvements in the quality of care . Optimisation of skin antisepsis is essential to prevent short-term catheter-related infections . We hypothesised that chlorhexidine-alcohol would be more effective than povidone iodine-alcohol as a skin antiseptic to prevent intravascular-catheter-related infections . METHODS In this open-label , r and omised controlled trial with a two-by-two factorial design , we enrolled consecutive adults ( age ≥18 years ) admitted to one of 11 French intensive-care units and requiring at least one of central -venous , haemodialysis , or arterial catheters . Before catheter insertion , we r and omly assigned ( 1:1:1:1 ) patients via a secure web-based r and om-number generator ( permuted blocks of eight , stratified by centre ) to have all intravascular catheters prepared with 2 % chlorhexidine-70 % isopropyl alcohol ( chlorhexidine-alcohol ) or 5 % povidone iodine-69 % ethanol ( povidone iodine-alcohol ) , with or without scrubbing of the skin with detergent before antiseptic application . Physicians and nurses were not masked to group assignment but microbiologists and outcome assessors were . The primary outcome was the incidence of catheter-related infections  with chlorhexidine-alcohol versus povidone iodine-alcohol in the intention-to-treat population . This study is registered with Clinical Trials.gov , number NCT01629550 and is closed to new participants . FINDINGS Between Oct 26 , 2012 , and Feb 12 , 2014 , 2546 patients were eligible to participate in the study . We r and omly assigned 1181 patients ( 2547 catheters ) to chlorhexidine-alcohol ( 594 patients with scrubbing , 587 without ) and 1168 ( 2612 catheters ) to povidone iodine-alcohol ( 580 patients with scrubbing , 588 without ) . Chlorhexidine-alcohol was associated with lower incidence of catheter-related infections ( 0·28 vs 1·77 per 1000 catheter-days with povidone iodine-alcohol ; hazard ratio 0·15 , 95 % CI 0·05 - 0·41 ; p=0·0002 ) . Scrubbing was not associated with a significant difference in catheter colonisation ( p=0·3877 ) . No systemic adverse events were reported , but severe skin reactions occurred more frequently in those assigned to chlorhexidine-alcohol ( 27 [ 3 % ] patients vs seven [ 1 % ] with povidone iodine-alcohol ; p=0·0017 ) and led to chlorhexidine discontinuation in two patients . INTERPRETATION For skin antisepsis , chlorhexidine-alcohol provides greater protection against short-term catheter-related infections than does povidone iodine-alcohol and should be included in all bundles for prevention of intravascular catheter-related infections . FUNDING University Hospital of Poitiers , CareFusion OBJECTIVE To compare the effectiveness for prevention of  central venous and arterial catheter colonization  of 3 skin antisepsis with 1 of 3 antiseptic solutions : 10 % aqueous povidone iodine ( aqueous PI ) , 2 % aqueous chlorhexidine gluconate ( aqueous CG ) , and 0.5 % alcoholic chlorhexidine gluconate ( alcoholic CG ) . DESIGN Prospect i ve , r and omized controlled trial . SETTING Intensive care unit in a teaching hospital . METHODS Patients were r and omly assigned to 1 of the 3 skin antisepsis groups . The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection . Rates of catheter colonization , catheter-related sepsis , and catheter-related bacteremia were compared among the 3 groups . RESULTS A total of 631 catheters were included in the study ( 194 from the aqueous PI group , 211 from the aqueous CG group , and 226 from the alcoholic CG group ) . The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group ( 14.2 % vs 24.7 % ; relative risk , 0.5 [ 95 % confidence interval , 0.3 - 0.8 ; P < .01 ] ) ; it was also significantly lower in the aqueous CG group than in the aqueous PI group ( 16.1 % vs 24.7 % ; relative risk , 0.6 [ 95 % confidence interval , 0.4 - 0.9 ; P = .03 ] ) . There were no significant differences between the aqueous CG and the alcoholic CG groups . Incidences of catheter-related bacteremia were similar for all 3 groups . The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria . CONCLUSIONS The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters . Both had significantly lower incidences of colonization than did the aqueous PI solution ; this effect seems to be related to the CG solutions ' more efficacious prevention of colonization with gram-positive bacteria OBJECTIVE To examine the extent to which US acute care hospitals have adopted recommended practice s to prevent  central venous catheter-related bloodstream infections ( CR-BSIs ) .  PARTICIPANTS AND METHODS Between March 16 , 2005 , and August 1 , 2005 , a survey of infection control coordinators was conducted at a national r and om sample of nonfederal hospitals with an intensive care unit and more than 50 hospital beds ( n=600 ) and at all Department of Veterans Affairs ( VA ) medical centers ( n=119 ) . Primary outcomes were regular use of 5 specific practice s and a composite approach for preventing CR-BSIs . RESULTS The overall survey response rate was 72 % ( n=516 ) . A higher percentage of VA compared to non-VA hospitals reported using  maximal sterile barrier pre caution s  ( 84 % vs 71 % ; P=.01 ) ;  chlorhexidine gluconate  for insertion site antisepsis ( 91 % vs 69 % ; P<.001 ) ; and a composite approach ( 62 % vs 44 % ; P=.003 ) combining concurrent use of maximal sterile barrier pre caution s , chlorhexidine gluconate , and avoidance of routine central line changes . Those hospitals having a higher safety culture score , having a certified infection control professional , and participating in an infection prevention collaborative were more likely to use CR-BSI prevention practice s. CONCLUSION Most US hospitals are using maximal sterile barrier pre caution s and chlorhexidine gluconate , 2 of the most strongly recommended practice s to prevent CR-BSIs . However , fewer than half of non-VA US hospitals reported concurrent use of maximal sterile barrier pre caution s , chlorhexidine gluconate , and avoidance of routine central line changes . Wider use of CR-BSI prevention practice s by hospitals could be encouraged by fostering a culture of safety , participating in infection prevention collaboratives , and promoting infection control professional certification BACKGROUND Long-term central venous catheterization  is associated with a higher rate of catheter-related blood stream infections ( CR-BSI ) . It is unclear whether there is a difference in the CR-BSI rate associated with central venous catheters 
    Output:
    
None of the individual subgroup comparisons of aqueous chlorhexidine versus aqueous povidone-iodine , alcoholic chlorhexidine versus aqueous povidone-iodine and alcoholic chlorhexidine versus alcoholic povidone-iodine showed clear differences for catheter-related BSI or mortality ( and were generally underpowered ) .
AUTHORS ' CONCLUSIONS It is not clear whether cleaning the skin around CVC insertion sites with antiseptic reduces catheter related blood stream infection compared with no skin cleansing .
Skin cleansing with chlorhexidine solution may reduce rates of CRBSI and catheter colonisation compared with cleaning with povidone iodine .
Moreover these results may be influenced by the nature of the antiseptic solution ( i.e. aqueous or alcohol-based ) .