Prevention of Intravascular Central Venous Catheter- Related Infections: 0.5% Concentration of Chlorhexidine Preparation With Alcohol for Skin Preparation and Femoral Vein for Renal Replacement

To the Editor—We read with great interest the article ‘‘Guidelines for the Prevention of Intravascular Catheter-related Infections’’ in the May 2011 issue [1]. We commend the authors for their excellent extensive review of the literature and subsequent guidelines. These guidelines, however, recommend the use of ‘‘.0.5% chlorhexidine preparation with alcohol for skin antisepsis during CVC insertion’’ [1]. We question the basis of the recommendation that the concentration of chlorhexidine should be higher than 0.5%. First, the meta-analysis by Chaiyakunapruk et al [2] is included in the guideline to affirm that chlorhexidine reduces the risk of catheter-related infection compared with povidone-iodine. The meta-analysis included studies using