Use of Cleansing Agents at the Peritoneal Catheter Exit Site

Abstract

Heavy bacterial colonization results in exit-site infection. Antiseptic and non antiseptic agents have both been used for exit-site cleansing. An ideal cleansing agent should not only reduce the number of microorganisms, but should also be harmless to the body's defenses and should not interfere with wound healing. In vitro studies using animal cells have demonstrated that some antiseptic agents have adverse effects on wound healing. Strong cytotoxic antiseptics should be discouraged in exit-site cleansing. In choosing an appropriate cleansing agent for exit-site care, the phase of wound healing, the condition of the exit site, and the goal of cleansing should be taken into consideration. Antimicrobial soap is recommended for cleansing a healed exit site, but biocompatible solution is preferred for the postoperative, infected, or traumatized exit site. In vivo studies on the effectiveness of some cleansing agents are still lacking, and clinical study of exit-site cleansing is needed to determine the most effective agents for the task.

ISPD Catheter-Related Infection Recommendations: 2017 Update

“…The addition of topical gentamicin cream does not help to eradicate ESI caused by Pseudomonas species (180). Acetic acid (vinegar) has been used as a wound antiseptic and has been recommended for treatment of Pseudomonas wounds infections (181). However, the experience of acetic acid for the treatment of ESI in PD patients is limited.…”

Comparison of normal saline and antiseptic solution effect on the early peristomal infection rates of patients with percutaneous endoscopic gastrostomy tubes: A randomized double‐blind study

“…4 One important measure is daily practice of sterile dressing to the peristomal area until the stoma canal is fully granulated, which is expected around day 7. 5,6 For peristomal area care, normal saline (NS), [6][7][8] soap, 9 and antiseptic solutions 2,10,11 are recommended. Although NS is not bactericidal, it is preferred as a wound-cleaning solution because it is unhazardous for the granulation tissue and bacterial flora, cheap, and not a common irritant.…”

“…8,12,13 Soaps successfully clean microorganisms on the skin; however, their alkaline nature can increase the slightly acidic pH of the skin. 11,14,15 Antiseptic solutions can have toxic effects on fibroblasts; their toxic effects continue even at low concentrations, and if compounds such as peroxide and iodine are used, they can cause at least as much damage to living tissue as bacteria. 16 One of the most common complications of PEG tube is peristomal infection, which is reported in 5%-65% of the cases.…”

“…Although NS is not bactericidal, it is preferred as a wound‐cleaning solution because it is unhazardous for the granulation tissue and bacterial flora, cheap, and not a common irritant 8,12,13 . Soaps successfully clean microorganisms on the skin; however, their alkaline nature can increase the slightly acidic pH of the skin 11,14,15 . Antiseptic solutions can have toxic effects on fibroblasts; their toxic effects continue even at low concentrations, and if compounds such as peroxide and iodine are used, they can cause at least as much damage to living tissue as bacteria 16 .…”