Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T11:29:15.041Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  28 December 2015

Charles E. Edmiston Jr ,
Candace J. Krepel ,
Maureen P. Spencer ,
Alvaro A. Ferraz ,
Gary R. Seabrook ,
Cheong J. Lee ,
Brian D. Lewis ,
Kellie R. Brown ,
Peter J. Rossi  and
Michael J. Malinowski
...Show all authors
Charles E. Edmiston Jr*
Affiliation:
Department of Surgery (Division of Vascular Surgery), Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin Surgical Microbiology Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Candace J. Krepel
Affiliation:
Department of Surgery (Division of Vascular Surgery), Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin Surgical Microbiology Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Maureen P. Spencer
Affiliation:
Infection Prevention Consultants, Boston, Massachusetts
Alvaro A. Ferraz
Affiliation:
Department of Surgery, Pernambuco University, Recife, Brazil
Gary R. Seabrook
Affiliation:
Department of Surgery (Division of Vascular Surgery), Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Cheong J. Lee
Affiliation:
Department of Surgery (Division of Vascular Surgery), Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Brian D. Lewis
Affiliation:
Department of Surgery (Division of Vascular Surgery), Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Kellie R. Brown
Affiliation:
Department of Surgery (Division of Vascular Surgery), Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Peter J. Rossi
Affiliation:
Department of Surgery (Division of Vascular Surgery), Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Michael J. Malinowski
Affiliation:
Department of Surgery (Division of Vascular Surgery), Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Sarah E. Edmiston
Affiliation:
Surgical Microbiology Research Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin
Edmundo M. Ferraz
Affiliation:
Department of Surgery, Pernambuco University, Recife, Brazil
David J. Leaper
Affiliation:
Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, United Kingdom
*
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).
Get access Rights & Permissions [Opens in a new window]

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 254 - 259
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

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.Google Scholar
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;122:160–166.Google Scholar
3. Reed, D, Kemmerly, SA. Infection control and prevention: a review of hospital-acquired infections and the economic implications. Oscher J 2009;9:27–31.Google Scholar
4. Shepard, J, Ward, W, Milstone, A, et al. Financial impact of surgical site infections on hospital: the hospital management perspective. JAMA Surg 2013;148:907–914.Google Scholar
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;37:387–397.Google Scholar
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;27:1291–1298.Google Scholar
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;201:76–83.Google Scholar
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.Google Scholar
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;27:97–132.Google Scholar
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;3:143–152.Google Scholar
11. Gignon, M, Ammirati, C, Mercier, R, Detave, M. Compliance with emergency department discharge instructions. Emerg Nurs 2014;40:51–55.Google Scholar
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;6:127–135.Google Scholar
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;219:256–264.Google Scholar
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.Google Scholar
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;207:233–239.Google Scholar
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.Google Scholar
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:S49–S55.Google Scholar
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;101:529–538.CrossRefGoogle ScholarPubMed
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;150:1027–1033.Google Scholar
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;92:509–518.Google Scholar
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;35:605–627.Google Scholar
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;12:169–177.Google Scholar
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;12:357–362.CrossRefGoogle ScholarPubMed