A Clinical Study Comparing the Skin Antisepsis and Safety of ChloraPrep, 70% Isopropyl Alcohol, and 2% Aqueous Chlorhexidine

Hibbard, John S.; Mulberry, Gayle; Brady, Ann R

doi:10.1097/00129804-200207000-00007

Cited by 109 publications

(64 citation statements)

References 7 publications

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“…This finding is supported by the results of other studies (11,17); on the abdominal skin, 2% CHG in 70% isopropanol provided a significantly more persistent antimicrobial activity than did isopropanol alone (11). It has been shown effective in the prevention of colonization of peripheral venous catheters (1,11,30).…”

Section: Discussionsupporting

confidence: 55%

Alcohols for Skin Antisepsis at Clinically Relevant Skin Sites

Reichel

Heisig

Kohlmann³

et al. 2009

Antimicrob Agents Chemother

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The antiseptic efficacy of ethanol, isopropanol, and n-propanol at 60%, 70%, and 89.5% (all vol/vol) was analyzed after 2, 3, or 4 min of application to the forehead, back, and abdomen of 180 volunteers by the use of a standardized swab sampling method. Results of recolonization by the aerobic skin flora of the upper arms and backs of 20 volunteers were compared 72 h after treatment with 0.5%, 1%, or 2% chlorhexidine digluconate (CHG) in 89.5% n-propanol. The most effective alcohol at all skin sites was n-propanol, with a mean log 10 reduction of 1.82 after 2 min on the forehead. Efficacy against the aerobic flora of the forehead was mainly influenced by the type of alcohol (P < 0.001), followed by the concentration (P < 0.001) and the application time (P ‫؍‬ 0.006). Ethanol and isopropanol were significantly less effective (both P < 0.001). Alcohol supplemented with 0.5% or more CHG was significantly more effective than alcohol alone in the suppression of recolonization (P < 0.05). An 89.5% solution of n-propanol was the most effective alcohol for the reduction of populations of aerobic skin flora. Its combination with CHG is appropriate whenever recolonization of the skin must be limited. Further studies are needed to determine the most effective concentration of CHG in npropanol to provide the best protection against recolonization of the skin, e.g., for catheter site care.In the United States and Europe, both ethanol and isopropanol are recognized active agents in medicinal products (7, 32), e.g., to prevent surgical-site infections as recommended by the Centers for Disease Control and Prevention (CDC). The U.S. Food and Drug Administration (FDA) assessed aqueous ethanol at 60% to 95% and isopropanol at 70% to 91.3% (vol/vol) as safe and effective for patient preoperative skin preparations (9). In Europe, n-propanol is also approved as an active ingredient in medicinal products for skin antisepsis.For catheter site care, the CDC strongly recommends the use of a 2% chlorhexidine-based preparation (24). The suppression of the recolonization of the catheter site is important because of the permanent gap in the skin barrier and the long intervals between dressing changes. Chlorhexidine is more effective than other standard preparations in preventing catheter colonization when used for catheter site care (33). It is also more effective in reducing bloodstream infection rates, which are the most important clinical endpoints (6,19,22).To the best of our knowledge, the levels of efficacy of the three alcohols used for skin antisepsis have never been studied systematically in vivo. Therefore, in this study, ethanol, isopropanol, and n-propanol were compared at three different concentrations and for three different application times at four clinically relevant skin sites to determine which of these antiseptic treatments is most effective in reducing the populations of aerobic skin flora. We then combined the most effective alcohol solutions identified with different concentrations of chlorhexidine digluconate (CHG) an...

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Section: Discussionsupporting

confidence: 55%

Alcohols for Skin Antisepsis at Clinically Relevant Skin Sites

Reichel

Heisig

Kohlmann³

et al. 2009

Antimicrob Agents Chemother

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“…Its antimicrobial activity is well established in vitro and in vivo and numerous studies have shown its efficacy in human and veterinary surgery. 21,[27][28][29] Quite some research has been performed on well-established antiseptics, but newer antiseptic surgical preparations, such as ECW and F10 have been subjected to limited evaluation in a veterinary clinical setting, especially in comparison to the well-established products.…”

Section: Literature Reviewmentioning

confidence: 99%

Comparative efficacy of three antiseptics as surgical skin preparations in dogs

Boucher

Henton²,

Becker

et al. 2018

Veterinary Surgery

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Objective To compare the antimicrobial efficacy of a 2% chlorhexidine gluconate and 70% ethanol solution (CG+A) with that of F10 Skin Prep Solution (F10) and electrochemically activated water (EAW) when used as a surgical preparation in canine patients. Study design Prospective randomized clinical study. Sample population One hundred sixteen dogs presented for ovariohysterectomy. Methods Dogs were randomly divided into 1 of the 3 antiseptic groups (CG+A, F10, EAW). Skin samples with replicating organism detection and counting plates were taken at 4 different perioperative sites and time intervals (postskin preparation, postskin antisepsis, 2 hours after the second sample, and at the end of surgery) during ovariohysterectomies performed by students. The colony forming unit (CFU) counts from each sample were quantified according to the level of bacterial contamination. Zero CFU was defined as no contamination, 1‐12 CFU was defined as low contamination, and greater than 12 CFU was defined as high contamination. The 3 antiseptics were compared with respect to the level of contamination. Results There was no difference in the level of colonization between the antiseptics at the first sampling time (P = .454). However, the level of contamination for CG+A was lower compared with F10 and EAW at the second, third, and fourth sampling times (P = .001, P = .01, P = .02, respectively). Conclusion CG+A was more effective at achieving a zero CFU count and low levels of contamination compared with F10 and EAW for surgical preparation in dogs undergoing ovariohysterectomy. Clinical significance This study does not provide evidence to support the use of F10 and EAW instead of CG+A for the surgical skin preparation of dogs undergoing ovariohysterectomy.

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“…However, a 2% (wt/vol) chlorhexidine solution is the recommended agent to be used prior to invasive procedures according to the EPIC (evidence-based practice in infection control) and CDC guidelines (18,19). Two percent chlorhexidine digluconate (CHG) has been shown to significantly reduce intravascular catheter-related infections (14), yet 2% (wt/vol) CHG in 70% (vol/vol) isopropyl alcohol demonstrates activity superior to that of aqueous CHG solution in a preoperative skin preparation (9) and in vitro carrier tests (1). However, little is known about the kinetics of chlorhexidine skin permeation from either of these solutions (11,25).…”

mentioning

confidence: 99%

Penetration of Chlorhexidine into Human Skin

Kärpänen

Worthington

Conway

et al. 2008

Antimicrob Agents Chemother

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This study evaluated a model of skin permeation to determine the depth of delivery of chlorhexidine into full-thickness excised human skin following topical application of 2% (wt/vol) aqueous chlorhexidine digluconate. Skin permeation studies were performed on full-thickness human skin using Franz diffusion cells with exposure to chlorhexidine for 2 min, 30 min, and 24 h. The concentration of chlorhexidine extracted from skin sections was determined to a depth of 1,500 m following serial sectioning of the skin using a microtome and analysis by high-performance liquid chromatography. Poor penetration of chlorhexidine into skin following 2-min and 30-min exposures to chlorhexidine was observed (0.157 ؎ 0.047 and 0.077 ؎ 0.015 g/mg tissue within the top 100 m), and levels of chlorhexidine were minimal at deeper skin depths (less than 0.002 g/mg tissue below 300 m). After 24 h of exposure, there was more chlorhexidine within the upper 100-m sections (7.88 ؎ 1.37 g/mg tissue); however, the levels remained low (less than 1 g/mg tissue) at depths below 300 m. There was no detectable penetration through the full-thickness skin. The model presented in this study can be used to assess the permeation of antiseptic agents through various layers of skin in vitro. Aqueous chlorhexidine demonstrated poor permeation into the deeper layers of the skin, which may restrict the efficacy of skin antisepsis with this agent. This study lays the foundation for further research in adopting alternative strategies for enhanced skin antisepsis in clinical practice.Effective skin antisepsis is essential in preventing infections associated with invasive procedures, such as intravascular catheter insertion or surgery. A range of skin antiseptic agents are available in the clinical setting, such as povidone-iodine and chlorhexidine compounds at various concentrations with alcoholic or aqueous solutions. However, a 2% (wt/vol) chlorhexidine solution is the recommended agent to be used prior to invasive procedures according to the EPIC (evidence-based practice in infection control) and CDC guidelines (18,19). Two percent chlorhexidine digluconate (CHG) has been shown to significantly reduce intravascular catheter-related infections (14), yet 2% (wt/vol) CHG in 70% (vol/vol) isopropyl alcohol demonstrates activity superior to that of aqueous CHG solution in a preoperative skin preparation (9) and in vitro carrier tests (1). However, little is known about the kinetics of chlorhexidine skin permeation from either of these solutions (11,25). Microorganisms colonizing the skin not only reside on the skin surface but are also found to inhabit hair follicles and lower skin depths (8). Many antimicrobial agents exhibit restricted permeation of the skin (8) and fail to reach the deeper layers, including the hair follicles, which harbor coagulasenegative staphylococci (2,7,8,13,15) and propionibacteria (13). Commensal microorganisms may therefore persist at the site of incision following skin antisepsis (4, 22), and such resident organisms may cause infec...

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A Clinical Study Comparing the Skin Antisepsis and Safety of ChloraPrep, 70% Isopropyl Alcohol, and 2% Aqueous Chlorhexidine

Cited by 109 publications

References 7 publications

Alcohols for Skin Antisepsis at Clinically Relevant Skin Sites

Alcohols for Skin Antisepsis at Clinically Relevant Skin Sites

Comparative efficacy of three antiseptics as surgical skin preparations in dogs

Penetration of Chlorhexidine into Human Skin

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