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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
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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).
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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 

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