Anna Casey1, Abdul Itrakjy2, Chrissie Birkett2, Alan Clethro2, Robert Bonser2, Tim Graham2, Jorge Mascaro2, Domenico Pagano2, Stephen Rooney2, Ian Wilson2, Peter Nightingale3, Cynthia Crosby4, Thomas Elliott5. 1. Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. 2. Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. 3. Wolfson Computer Laboratory, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. 4. CareFusion Corporation, San Diego, CA. 5. Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. Electronic address: tom.elliott@uhb.nhs.uk.
Abstract
BACKGROUND:Chlorhexidine gluconate (CHG) is often recommended for skin antisepsis; however, the most efficacious concentration is currently unclear. Our objective was to compare the efficacy of 70% isopropyl alcohol (IPA) containing either 0.5% or 2% CHG for antiseptic skin preparation in patients undergoing coronary artery bypass grafting. METHODS:One hundred patients were randomized to 1 of the 2 CHG concentrations. The designated antiseptic was applied to the skin of the operative site of patients before long saphenous vein harvest. Bacterial counts on the skin incision site were determined at various time points to assess any immediate and persistent antimicrobial activity. The number of patients developing surgical site infection was also determined. RESULTS: The total numbers of microorganisms on the skin 2 minutes after skin antisepsis and after wound closure was lower with 2% CHG/70% IPA compared with 0.5% CHG/70% IPA (P = .033 and P = .016, respectively). Six of 41 patients in the 0.5% CHG/70%IPA group developed a superficial surgical site infection compared with 2 of 44 patients in the 2% CHG/70% IPA group (relative risk, 3.22; 95% confidence interval, 0.63-22.75; P = .147). CONCLUSIONS:Isopropyl alcohol (70%) containing 2% CHG compared with 0.5% CHG reduces the number of microorganisms detectable on a surgical patient's skin perioperatively.
RCT Entities:
BACKGROUND:Chlorhexidine gluconate (CHG) is often recommended for skin antisepsis; however, the most efficacious concentration is currently unclear. Our objective was to compare the efficacy of 70% isopropyl alcohol (IPA) containing either 0.5% or 2% CHG for antiseptic skin preparation in patients undergoing coronary artery bypass grafting. METHODS: One hundred patients were randomized to 1 of the 2 CHG concentrations. The designated antiseptic was applied to the skin of the operative site of patients before long saphenous vein harvest. Bacterial counts on the skin incision site were determined at various time points to assess any immediate and persistent antimicrobial activity. The number of patients developing surgical site infection was also determined. RESULTS: The total numbers of microorganisms on the skin 2 minutes after skin antisepsis and after wound closure was lower with 2% CHG/70% IPA compared with 0.5% CHG/70% IPA (P = .033 and P = .016, respectively). Six of 41 patients in the 0.5% CHG/70%IPA group developed a superficial surgical site infection compared with 2 of 44 patients in the 2% CHG/70% IPA group (relative risk, 3.22; 95% confidence interval, 0.63-22.75; P = .147). CONCLUSIONS:Isopropyl alcohol (70%) containing 2% CHG compared with 0.5% CHG reduces the number of microorganisms detectable on a surgical patient's skin perioperatively.
Authors: A Charehbili; M B G Koek; J C A de Mol van Otterloo; M W G A Bronkhorst; P van der Zwaal; B Thomassen; E J Waasdorp; J A Govaert; A Bosman; J van den Bremer; A J Ploeg; H Putter; A P Meijs; C J H van de Velde; W van Gijn; R J Swijnenburg Journal: BJS Open Date: 2019-05-20