The question popped up on an Intensive Care ward round when it was posed that despite clinicians washing their hands multiple times per patient per day, whether an unwashed patient could pose an infection risk to themselves or others. Another quiet voice at the back wondered if there was any merit to having patients wash with chlorhexidine? This is a brief review of three papers looking at chlorhexidine bathing in three clinical settings. Chlorhexidine washes appear to reduce the skin bioburden in patients.
This landmark clinical trial demonstrated a dramatic effect of chlorhexidine—alcohol as a preoperative antiseptic surgical prep agent on surgical site infection. Chlorhexidine—alcohol was significantly more protective than povidone—iodine against both superficial incisional infections 4.
However, the evidence for chlorhexidine may not be air tight, and some think it is in evolution. SCOAP surgeons want to know about all the data so they can make more informed decisions.
SCOAP is also a natural laboratory for studying the impact of different surgical practice on outcomes.
A prior study by Swenson et al sought to compare the effects of different skin preparation solutions on surgical-site infection rates by performing a longitudinal study where they changed the skin prep every few months.
However, the authors acknowledged that their study had limitations which would prevent widespread application of its findings. The study was not randomized, did not control for other infection control variables, and took place in a single academic medical center. Other factors, such as a lack of compliance to study protocols and environmental changes during the study period, were also noted.
Because of these limitations, the findings are not comparable in strength of evidence, but were reviewed carefully before the change to the checklist was made.
Is it worth it? It is estimated that one in seventeen surgical site infections will be prevented by this change, and current estimates for the cost of such an infection range from several thousand to tens of thousands of dollars. Clearly, this is a low-cost intervention with big savings potential.
Prevention of surgical site infection is, of course, not limited to a single intervention. Each separately may decrease the risk by one-third. Done together, they combine to provide a powerful advantage to our patients.
So for now, ask for chlorhexidine-alcohol for skin prep unless contraindicated for your patients, and SCOAP will continue to monitor whether this simple change helps prevent infection.application of chlorhexidine gluconate to an organ or mucous membranes Chlorhexidine gluconate must be allowed to dry on the skin before a dressing can be placed to prevent an adverse skin reaction.
Pediatric and neonatal research related to use of chlorhexidine gluconate is . Evidence supports preoperative use of alcohol and/or chlorhexidine scrubbing of surgical sites 1 or hospital staff hands 2,3 to reduce the incidence of surgical site .
Reducing the Rate of Surgical Site Infections After Breast Surgery With the Use of Larger Volumes of 4% Chlorhexidine Gluconate Solution as Preoperative Antiseptic Showering. Infection Control & Hospital Epidemiology, Vol.
38, Issue. 03, p. Research on the use of chlorhexidine for SSI prevention in cesarean sections is limited.
This study intends to evaluate the effectiveness of use of both chlorhexidine gluconate (CHG) wipe and vaginal scrub in reducing SSI in patients undergoing cesarean section that have previously been laboring. Standardizing Surgical Skin Antisepsis Protocols PRESENTED BY SHARON L.
BUTLER, •Use chlorhexidine-based gluconate (CHG) 2% and isopropyl alcohol solution as with CHG as a part of pre-op bathing at home before surgery) –For maximum efficacy, ensure compliance by reinforcing the bathing process. Conclusion: At-home use of chlorhexidine gluconate wipes did not decrease the topical bacterial burden.
Therefore, using chlorhexidine gluconate wipes at home before surgery .