Combined skin disinfection with chlorhexidine/propanol and aqueous povidone-iodine reduces bacterial colonisation of central venous catheters

Langgartner, Julia; Linde, Hans-Jörg; Lehn, Norbert; Reng, Michael; Schölmerich, Jürgen; Glück, Thomas

doi:10.1007/s00134-004-2282-9

Cited by 66 publications

(49 citation statements)

References 27 publications

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“…17 The approach is also supported by a number of studies that have demonstrated better decontamination rates of skin microorganisms at the incision site with double-agent skin preparation. 13,[18][19][20][21] We accept that this is a retrospective analysis, and may therefore be biased by incomplete case acertainment due the skin preparation type having not been recorded for all surveillance cases. We do, however, have robust prospective identification of all patients, a robust definition of SSI and the prospective follow-up of patients to record the occurrence of an SSI, which allows for a meaningful interpretation of our data.…”

Section: Discussionmentioning

confidence: 99%

Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Davies

Patel

2016

annals

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INTRODUCTION Surgical site infection (SSI) is a significant cause of postoperative morbidity and mortality. Effective preoperative antisepsis is a recognised prophylactic, with commonly used agents including chlorhexidine (CHG) and povidone-iodine (PVI). However, there is emerging evidence to suggest an additional benefit when they are used in combination. METHODS We analysed data from our prospective SSI database on patients undergoing clean cranial neurosurgery between October 2011 and April 2014. We compared the case-mix adjusted odds of developing a SSI in patients undergoing skin preparation with CGH or PVI alone or in combination. RESULTS SSIs were detected in 2.6% of 1146 cases. Antisepsis with PVI alone was performed in 654 (57%) procedures, while 276 (24%) had CHG alone and 216 (19%) CHG and PVI together. SSIs were associated with longer operating time (p<0.001) and younger age (p=0.03). Surgery type (p<0.001) and length of operation (p<0.001) were significantly different between antisepsis groups. In a binary logistic regression model, CHG and PVI was associated with a significant reduction in the likelihood of developing an SSI (adjusted odds ratio [AOR] 0.12, 95% confidence interval [CI] 0.02-0.63) than either agent alone. There was no difference in SSI rates between CHG and PVI alone (AOR 0.60, 95% CI 0.24-1.5). CONCLUSIONS Combination skin preparation with CHG and PVI significantly reduced SSI rates compared to CHG or PVI alone. A prospective, randomized study validating these findings is now warranted.

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Section: Discussionmentioning

confidence: 99%

Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Davies

Patel

2016

annals

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“…[9,10] 2) Cleaning the skin with alcoholic chlorhexidine 0.5%. [11,12] 3) Using a checklist during catheter insertion to ensure adherence to infection-control practices. 4) Using the subclavian vein as the preferred insertion site and avoiding the femoral vein if possible And 5) Daily evaluation to determine whether catheters were unnecessary and could be removed [13,14,15,16,17,18].…”

Section: Methodsmentioning

confidence: 99%

Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention

Peredo

Sabatier

Villagrá

et al. 2010

Eur J Clin Microbiol Infect Dis

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“…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 infection when the protective skin barrier is breached during surgical procedures (12,20,26). Therefore, effective and rapid permeation of the applied antiseptic agent into the deeper layers of the skin is essential in preventing infections associated with invasive procedures.…”

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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Combined skin disinfection with chlorhexidine/propanol and aqueous povidone-iodine reduces bacterial colonisation of central venous catheters

Cited by 66 publications

References 27 publications

Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention

Penetration of Chlorhexidine into Human Skin

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