Preoperative Shower Revisited: Can High Topical Antiseptic Levels Be Achieved on the Skin Surface Before Surgical Admission?
Received 13 November 2007; received in revised form 30 November 2007; accepted 14 December 2007. published online 06 May 2008.
Background
Skin asepsis is a sentinel strategy for reducing risk of surgical site infections. In this study, chlorhexidine gluconate (CHG) skin concentrations were determined after preoperative showering/skin cleansing using 4% CHG soap or 2% CHG-impregnated polyester cloth.
Study Design
Subjects were randomized to one of three shower (4% soap)/skin cleansing (2% cloth) groups (n = 20 per group): (group 1 A/B) evening, (group 2 A/B) morning, or (group 3 A/B) evening and morning. After showering or skin cleansing, volunteers returned to the investigator's laboratory where CHG skin surface concentrations were determined at five separate skin sites. CHG concentrations were compared with CHG minimal inhibitory concentration that inhibits 90% (MIC90) of staphylococcal skin isolates.
Results
CHG MIC90 for 61 skin isolates was 4.8 parts per million (ppm). In group 1A, 4% CHG skin concentrations ranged from 17.2 to 31.6 ppm, and CHG concentrations were 361.5 to 589.5 ppm (p < 0.0001) in group 1B (2%). In group 2A (4%), CHG levels ranged from 51.6 to 119.6 ppm and 848.1 to 1,049.6 ppm in group 2B (2%), respectively (p < 0.0001). CHG levels ranged from 101.4 to 149.4 ppm in the 4% CHG group (group 3A) compared with 1,484.6 to 2,031.3 ppm in 2% CHG cloth (group 3B) group (p < 0.0001). Effective CHG levels were not detected in the 4% CHG group in selected sites in seven (35%) subjects in group 1A, three (15%) in group 2A, and five (25%) in group 3A.
Conclusions
Effective CHG levels were achieved on most skin sites after using 4% CHG; gaps in antiseptic coverage were noted at selective sites even after repeated application. Use of the 2% CHG polyester cloth resulted in considerably higher skin concentrations with no gaps in antiseptic coverage. Effective decolonization of the skin before hospital admission can play an important role in reducing risk of surgical site infections.
Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI.
Correspondence address: Charles E Edmiston Jr, PhD, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI 53226.
Disclosure Information: The following disclosure has been reported by the author: Dr Edmiston received an unrestricted research grant as an investigator for Sage Products, Inc. No one derived personal compensation from this grant. The grant was used, in part, to purchase supplies such as the 4% CHG and the 2% CHG cloths along with other material used in the study. These monies were also used to support other research activities in the laboratory that are not related to any skin-prepping product.
This study was also supported by monies from our Surgical Microbiology Research Laboratory Fund, a separate independent fund administered by the Department of Surgery, Medical College of Wisconsin that is used for research support.
ABSTRACT