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

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.

Empowering the surgical patient: a randomized, prospective analysis of an innovative strategy for improving patient compliance with preadmission showering protocol.

BACKGROUND: Surgical site infections (SSIs) are responsible for significant morbidity, mortality, and excess use of health care resources. The preadmission antiseptic shower is accepted as an effective strategy for reducing the risk for SSIs. The study analyzes the benefit of an innovative electronic patient alert system (EAS) for enhancing compliance with a preadmission showering protocol with 4% chlorhexidine gluconate (CHG). STUDY DESIGN: After providing informed consent, 80 volunteers were randomized to 4 CHG showering groups. Groups A1 and A2 showered twice. Group A1 was prompted to shower via EAS. Groups B1 and B2 showered 3 times. Group B1 was prompted via EAS. Subjects in groups A2 and B2 were not prompted (non-EAS groups). Skin-surface concentrations of CHG (µg/mL) were analyzed using colorimetric assay at 5 separate anatomic sites. Study personnel were blinded to the randomization code; after final volunteer processing, the code was broken and individual groups were analyzed. RESULTS: Mean composite CHG skin-surface concentrations were significantly higher (p < 0.007) in EAS groups A1 (30.9 ± 8.8 µg/mL) and B1 (29.0 ± 8.3 µg/mL) compared with non-EAS groups A2 (10.5 ± 3.9 µg/mL) and B2 (9.5 ± 3.1 µg/mL). Overall, 66% and 67% reductions in CHG skin-surface concentrations were observed in non-EAS groups A2 and B2 compared with EAS study groups. Analysis of returned (unused) CHG (mL) suggests that a wide variation in volume of biocide was used per shower in all groups. CONCLUSIONS: The findings suggest that EAS was effective in enhancing patient compliance with a preadmission showering protocol, resulting in a significant (p < 0.007) increase in skin-surface concentrations of CHG compared with non-EAS controls. However, variation in amount of unused 4% CHG suggests that rigorous standardization is required to maximize the benefits of this patient-centric interventional strategy.