Effectiveness of surgical hand antisepsis using chlorhexidine digluconate and parachlorometaxylenol hand scrub

Abstract

Background:Chlorhexidine and parachlorometaxylenol (PCMX) are antiseptics recommended for surgical hand antisepsis. To our knowledge, PCMX has not been evaluated for bactericidal efficacy “in vivo.Methods:We conducted a randomized, double-blind, controlled crossover trial to compare the bacterial loads on fingertips and fingernails under laboratory conditions after use of antiseptic test products, including chlorhexidine digluconate 4%, PCMX 3%, and a reference solution of propan-1-ol 60% (P-1). We assessed bacterial load after a prewash with soft soap, immediately after application of an antiseptic, and 3 hours after application and wearing of sterile, powder-free gloves. Our procedures followed those specified by European Norm (EN) 12791 for evaluating surgical hand antiseptics and using cotton swab for fingertips and fingernails.Results:Chlorhexidine digluconate 4% and PCMX 3% did not decrease bacterial load on the hands. The bactericidal performances of chlorhexidine digluconate 4% and PCMX 3% did not differ significantly. Chlorhexidine digluconate 4% and PCMX 3% increased bacterial load on the fingertips after participants had worn gloves for 3 hours. Fingernails had greater bacterial loads than skin on the fingertips.Conclusions:Chlorhexidine digluconate 4% and PCMX 3% had similar bactericidal efficacy, but they failed to meet the EN 12791 efficacy standard. Fingernails should be a particular focus of antisepsis in preparation for surgery.The trial was registered at ClinicalTrials.gov (ID: NCT02500758).

Effect on the reduction of bacterial load after surgical hand antisepsis with triclosan 0.5% compared to triclosan 0.5% followed by 70% alcoholic solution

“…None of them met the UNE criteria applied by scrubbing instead of by rubbing. 6,9 The scrub technique appears to promote the outcrop of bacteria from the deep folds of the skin. 1,6 For TCS þ EtA strategy, the immediate and 3-hour effects were lower but not significantly inferior to those of the reference procedure, meeting the UNE noninferiority criterion but not the requirement for claiming an additional sustained effect.…”

“…The test was repeated with changed roles in second and third sessions with a washout period of 1 week between runs to allow the reconstitution of skin microbiota. 5,6 Participants did not use antimicrobials or hand antiseptics for at least 3 days prior to the test.…”

Alcohol-Based Chlorhexidine and Potassium Sorbate Rub Strengthens the Effectiveness of Traditional Hand Scrubbing and Improves Long-Lasting Effectiveness—Evaluation of Hand Preparation Protocols According to EN 12791

“…Based on the results of in vitro tests and non-standardized clinical trials, health professionals consider medicated soaps to be effective [9,[17][18][19], but the antimicrobial activity of these antiseptics differs significantly under practical conditions, such as those proposed by EN 12791 [20][21][22][23]. Medicated soaps containing PVP 10%, TC 0.5-1% or PCMX 3% do not meet the non-inferiority criteria of EN 12791 and should not be used in surgical hand scrubbing [20][21][22][23]. In this context, CHG 4% soaps have resulted in an inferior immediate effect compared to n-propanol, or non-inferiority without the sustained effect expected for this long-lasting agent when applied for 3 to 5 min [18,[20][21][22]24].…”

“…Medicated soaps containing PVP 10%, TC 0.5-1% or PCMX 3% do not meet the non-inferiority criteria of EN 12791 and should not be used in surgical hand scrubbing [20][21][22][23]. In this context, CHG 4% soaps have resulted in an inferior immediate effect compared to n-propanol, or non-inferiority without the sustained effect expected for this long-lasting agent when applied for 3 to 5 min [18,[20][21][22]24]. The rinsing of the antiseptic after hand disinfection and the deleterious effect of scrubbing on the nail hyponychium contribute greatly to the infectivity of surgical hand scrubbing [21,22,25].…”

“…For these reasons, several studies have suggested the use of multi-stage disinfection protocols to ensure that traditional hand scrubbing meets the requirements of EN 12791 [21][22][23]. Protocols that supplemented traditional hand scrubbing with a rub using CHG or PVP aqueous solutions or alcohol-based solutions met the non-inferiority requirement [21][22][23], but only traditional hand scrubbing with CHG 4% followed by rubbing with aqueous CHG 5% showed sustained effects at the cost of a marked increase in the duration of the process [21]. Despite the improved effectiveness, a balance between the effectiveness and duration of the disinfection process is needed to promote adherence to the disinfection procedure [22,23].…”