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Antiseptic-impregnated Cloths May Be More Effective Than Antiseptic Soap in Skin Decolonisation: Presented at ACS

By John Gever

NEW ORLEANS, LA -- October 11, 2007 -- Cloths impregnated with chlorhexidine gluconate (CHG), a common antiseptic agent, appear more likely to produce effective preoperative decolonisation of skin microbes than CHG soaps, according to research presented here at the 93rd Annual Clinical Congress of the American College of Surgeons (ACS).

Antiseptics are applied to all patients being prepared for surgery to minimise the risk of infections. The effectiveness of various antiseptic approaches is now under scrutiny, thanks to increased efforts at many hospitals to reduce the incidence of surgical-site infections (SSIs).

Results from a randomised, prospective, cross-over study involving 60 subjects were reported in a poster here on October 8th by Charles E. Edmiston Jr., PhD, Professor of Surgery and Hospital Epidemiologist, Medical College of Wisconsin, Milwaukee, Wisconsin, United States, and colleagues.

Healthy subjects were assigned to one of three groups: those applying a CHG-containing product (4% CHG body wash or 2% CHG cloth) in 1) the morning, 2) the evening, or 3) both. Subjects initially showered with the body wash, with instructions to apply it with a washcloth once, rinse, and then apply it again with a washcloth to the arms, legs and abdomen (including the navel) and wait 2 minutes before rinsing.

After a 1-week washout period, the protocol was repeated with the CHG cloths, except that subjects were not to rinse it off. Following each application of body wash or cloth, subjects went to the laboratory for measurement of residual CHG at several sites on their bodies.

In the body-wash phase of the study, mean CHG levels at all skin sites exceeded 4.8 parts per million (ppm), the concentration reported in the literature to inhibit microbes at the 50% level. According to Dr. Edmiston's group, however, the measured CHG levels fell below the 4.8 ppm threshold at some skin sites in several individual subjects using the body wash.

In contrast, all subjects using the antiseptic cloths showed CHG concentrations higher than 4.8 ppm at all skin sites. Mean overall CHG levels with the cloths exceeded those found with the soap by 12- to 23-fold at the different skin sites (P <.001).

The group speculated that the soap may have been less effective because it was diluted during showering. Also, according to the researchers, the design of the CHG-impregnated cloths, featuring a tight fabric weave, may promote greater skin exfoliation and antiseptic penetration into deeper recesses.

The poster concluded that the higher overall CHG concentration and the reduced variability associated with the cloths are likely to produce more effective preoperative decolonisation in surgical patients.

The trial was partially funded by Sage Products Inc., manufacturer of the CHG-impregnated cloths.


[Presentation title: Reducing the Risk of SSIs: Evaluating Skin Antisepsis Using 4% Chlorhexidine Gluconate (CHG) Soap Versus 2% CHG-Impregnated Polyester Cloth.]

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