One of the weapons in an infection preventionist’s arsenal is chlorhexidine gluconate (CHG), an antimicrobial agent used as a surgical scrub, hand antiseptic and dental rinse, depending upon the percentage used in the formulation. CHG is becoming ubiquitious in the marketplace because of its efficacy against Gram-positive and Gram-negative organisms, aerobes, anaerobes and yeast.
CHG-based products play an important role in the prevention of hospital-acquired infections (HAIs) in several ways.
First, this antimicrobial agent can help prevent surgical site infections (SSIs), one of the most common HAIs responsible for at least 3.7 million additional days of hospitalization and a cost of at least $1.6 billion in hospital charges annually in the United States.
Among the preoperative steps recommended in the Guideline for Prevention of Surgical Site Infection (1999) from the Centers for Disease Prevention and Control (CDC) is the preoperative shower (although it has not been definitively shown to prevent SSIs) and preoperative surgical skin prep and surgical scrub using an FDA-approved antiseptic specifically designed for these purposes. The SSI guidelines cites a study of 700-plus patients who received two preoperative antiseptic showers; chlorhexidine gluconate was shown to reduce bacterial colony counts ninefold (2.83102 to 0.3), while povidone iodine or triclocarban-medicated soap reduced colony counts by 1.3- and 1.9-fold, respectively. While a number of broad-spectra antiseptic agents are available for preoperative preparation of patients’ skin at the incision site (including iodophors, alcohol-containing products and CHG), the SSI guideline notes, “In some comparisons of the two antiseptics when used as preoperative hand scrubs, chlorhexidine gluconate achieved greater reductions in skin microflora than did povidone iodine and also had greater residual activity after a single application. Further, chlorhexidine gluconate is not inactivated by blood or serum proteins.”
For the surgical scrub by operating room personnel, the SSI guidelines mandates that the product have a broad spectrum of activity, be fast-acting and have a persistent effect. Among the common antiseptic agents available for this purpose are alcohol, chlorhexidine, iodine/iodophors, parachlorometa-xylenol and triclosan, the SSI guidelines notes, “Povidone iodine and chlorhexidine gluconate are the current agents of choice for most U.S. surgical team members.”
