Skip to main content Accessibility help
×
Home

Preadmission Application of 2% Chlorhexidine Gluconate (CHG): Enhancing Patient Compliance While Maximizing Skin Surface Concentrations

  • Charles E. Edmiston (a1) (a2), Candace J. Krepel (a1) (a2), Maureen P. Spencer (a3), Alvaro A. Ferraz (a4), Gary R. Seabrook (a1), Cheong J. Lee (a1), Brian D. Lewis (a1), Kellie R. Brown (a1), Peter J. Rossi (a1), Michael J. Malinowski (a1), Sarah E. Edmiston (a2), Edmundo M. Ferraz (a4) and David J. Leaper (a5)...

Abstract

OBJECTIVE

Surgical site infections (SSIs) are responsible for significant morbidity and mortality. Preadmission skin antisepsis, while controversial, has gained acceptance as a strategy for reducing the risk of SSI. In this study, we analyze the benefit of an electronic alert system for enhancing compliance to preadmission application of 2% chlorhexidine gluconate (CHG).

DESIGN, SETTING, AND PARTICIPANTS

Following informed consent, 100 healthy volunteers in an academic, tertiary care medical center were randomized to 5 chlorhexidine gluconate (CHG) skin application groups: 1, 2, 3, 4, or 5 consecutive applications. Participants were further randomized into 2 subgroups: with or without electronic alert. Skin surface concentrations of CHG (μg/mL) were analyzed using a colorimetric assay at 5 separate anatomic sites.

INTERVENTION

Preadmission application of chlorhexidine gluconate, 2%

RESULTS

Mean composite skin surface CHG concentrations in volunteer participants receiving EA following 1, 2, 3, 4, and 5 applications were 1,040.5, 1,334.4, 1,278.2, 1,643.9, and 1,803.1 µg/mL, respectively, while composite skin surface concentrations in the no-EA group were 913.8, 1,240.0, 1,249.8, 1,194.4, and 1,364.2 µg/mL, respectively (ANOVA, P<.001). Composite ratios (CHG concentration/minimum inhibitory concentration required to inhibit the growth of 90% of organisms [MIC90]) for 1, 2, 3, 4, or 5 applications using the 2% CHG cloth were 208.1, 266.8, 255.6, 328.8, and 360.6, respectively, representing CHG skin concentrations effective against staphylococcal surgical pathogens. The use of an electronic alert system resulted in significant increase in skin concentrations of CHG in the 4- and 5-application groups (P<.04 and P<.007, respectively).

CONCLUSION

The findings of this study suggest an evidence-based standardized process that includes use of an Internet-based electronic alert system to improve patient compliance while maximizing skin surface concentrations effective against MRSA and other staphylococcal surgical pathogens.

Infect. Control Hosp. Epidemiol. 2016;37(3):254–259

Copyright

Corresponding author

Address correspondence to Charles E. Edmiston, Jr., PhD, Division of Vascular Surgery, 9200 West Wisconsin Avenue, Medical College of Wisconsin, Milwaukee, Wisconsin 53226 (edmiston@mcw.edu).

References

Hide All
1. National Hospital Discharge Survey: 2010 table, Procedures by selected patient characteristics—number by procedure category and age. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/fastats/inpatient -surg.htm. Published 2010. Updated August 9, 2015. Accessed August 11, 2015.
2. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160166.
3. Reed, D, Kemmerly, SA. Infection control and prevention: a review of hospital-acquired infections and the economic implications. Oscher J 2009;9:2731.
4. Shepard, J, Ward, W, Milstone, A, et al. Financial impact of surgical site infections on hospital: the hospital management perspective. JAMA Surg 2013;148:907914.
5. De Lissovoy, G, Fraeman, K, Hutchins, V, Murphy, D, Song, D, Vaughn, BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387397.
6. Herwaldt, LA, Cullen, JJ, Scholz, D, et al. A prospective study of outcome, healthcare resource utilization, and cost associated with postoperative nosocomial infections. Infect Control Hosp Epidemiol 2006;27:12911298.
7. Meeks, DW, Lally, KP, Carrick, MM, et al. Compliance with guidelines to prevent surgical site infections: as simple as 1-2-3? Am J Surg 2011;201:7683.
8. Ambulatory Surgery in the United States, 2006. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/data/nhsr/nhsr011.pdf. Published 2009. Accessed August 1, 2015.
9. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. The Hospital Infection Control Practice Advisory Committee: guidelines for the prevention of surgical site infections. Am J Infect Control 1999;27:97132.
10. Jakobsson, J, Perlkvist, A, Wann-Hansson, C. Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: a systematic review. Worldview Evidence-Based Nurs 2011;3:143152.
11. Gignon, M, Ammirati, C, Mercier, R, Detave, M. Compliance with emergency department discharge instructions. Emerg Nurs 2014;40:5155.
12. Fenerty, SD, West, C, Davis, SA, Kaplan, SG, Feldman, SR. The effect of reminder systems on patient’s adherence to treatment. Patient Preference Adherence 2012;6:127135.
13. Edmiston, CE, Krepel, CJ, Edmiston, SE, et al. Empowering the surgical patient: a randomized, prospective analysis of an innovative strategy for improving patient compliance to the preadmission showering protocol. J Am Coll Surgeons 2014;219:256264.
14. The USP Official Monograph for the identification of chlorhexidine gluconate solution. The United States Pharmacopeia (USP 29). The National Formulary (NF 24). Rockville, MD: The United States Pharmacopeia Convention; 2006: 477–478.
15. Edmiston, CE, Krepel, CJ, Seabrook, GR, Lewis, BD, Brown, KR, Towne, JB. The preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface prior to surgical admission? J Am Coll Surg 2008;207:233239.
16. Webster, J, Osborne, S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2015 Feb 20;2:CD004985.
17. Edmiston, CE, Bruden, B, Rucinski, M, Henen, C, Graham, MB, Lewis, BL. Reducing the risk of surgical site infections: does chlorhexidine gluconate provide a risk reduction benefit? Am J Infect Control 2013;41:S49S55.
18. Edmiston, CE, Assadian, O, Spencer, M, Olmsted, RN, Barnes, S, Leaper, D. To bathe or not to bathe with chlorhexidine gluconate: is it time to take a stand for the preadmission shower/cleansing? AORNJ 2015;101:529538.
19. Edmiston, CE, Lee, CJ, Krepel, CJ, et al. Evidence for preadmission showering regimen to achieve maximal antiseptic skin surface concentrations of chlorhexidine gluconate, 4%, in surgical patients. JAMA Surg 2015;150:10271033.
20. Edmiston, CE, Okoli, O, Graham, MB, Sinski, S, Seabrook, GR. Improving surgical outcomes: an evidence-based argument for embracing a chlorhexidine gluconate (CHG) preoperative shower (cleansing) strategy for elective surgical procedures. AORNJ 2010;92:509518.
21. Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605627.
22. Edmiston, CE, Spencer, M, Lewis, BD, et al. Reducing the risk of surgical site infections: Did we really think that SCIP would lead us to the promised land? Surg Infect 2011;12:169177.
23. Leaper, D, Tanner, J, Kiernan, M, Assadian, O, Edmiston, CE. Surgical site infection: poor compliance with guidelines and care bundles. Int Wound J 2015;12:357362.

Related content

Powered by UNSILO

Preadmission Application of 2% Chlorhexidine Gluconate (CHG): Enhancing Patient Compliance While Maximizing Skin Surface Concentrations

  • Charles E. Edmiston (a1) (a2), Candace J. Krepel (a1) (a2), Maureen P. Spencer (a3), Alvaro A. Ferraz (a4), Gary R. Seabrook (a1), Cheong J. Lee (a1), Brian D. Lewis (a1), Kellie R. Brown (a1), Peter J. Rossi (a1), Michael J. Malinowski (a1), Sarah E. Edmiston (a2), Edmundo M. Ferraz (a4) and David J. Leaper (a5)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.