Do chlorhexidine Preoperative showers reduce postoperative infections versus no Chlorhexidine showers?

Do chlorhexidine Preoperative showers reduce postoperative infections versus no Chlorhexidine showers?

Introduction

Health care-associated infections (HAIs), the most common adverse events encountered by hospitalized patients, complicate the hospital course of up to 10% of people who are admitted to acute care hospitals. These often serious infections result in significantly increased patient morbidity, mortality, length of stay, and utilization of health care resources. As health care technology advances, ironically, so do rates of HAI. Novel uses of experienced products are being implemented to combat these challenging infections. Here, we review decades of experience with an increasingly popular antiseptic, chlorhexidine (Garibaldi, 1988).

In this review, we focus on applications of chlorhexidine as an infection control tool to prevent HAI and present evidence for the use of chlorhexidine to decontaminate both people and devices (table 1). In addition, we address safety concerns, such as development of drug resistance and adverse drug reactions. Additional areas of needed research are addressed, highlighting high-risk populations that may benefit from chlorhexidine interventions but for whom data are currently lacking (Darouiche & Matthew et al. 2010).

Table 1: Evidence supporting selected uses of chlorhexidine for infection control

Background of the Study

Spectrum of Antiseptic Activity and Antiseptic Resistance

Chlorhexidine is a topical antiseptic solution that has been used worldwide since 1954. Its use in children and adults has provided an excellent record of safety and efficacy for applications as diverse as hand washing, preoperative skin preparation, vaginal antisepsis, treatment of gingivitis, and body washes to prevent neonatal sepsis. Chlorhexidine gluconate is a water-soluble, cationic biguanide that binds to the negatively charged bacterial cell wall, altering the bacterial cell osmotic equilibrium. Chlorhexidine is commercially available at a variety of concentrations (0.5%-4%) and formulations (with and without isopropyl alcohol or ethanol), and certain chlorhexidine-containing products are available over the counter. Because chlorhexidine-containing products come in many formulations and concentrations, we use “chlorhexidine” in this review to encompass chlorhexidine-containing solutions (Garibaldi, 1988). At low concentrations, chlorhexidine affects membrane integrity, but at high concentrations, cytoplasmic contents precipitate, resulting in cell death. Chlorhexidine (0.05% solution) has broad activity against gram-positive and gram-negative bacteria, facultative anaerobes and aerobes, yeasts, and some lipid-enveloped viruses, including HIV. Chlorhexidine is not sporicidal (Paulson, 1993).

Although decreased susceptibility to chlorhexidine has been reported, it has not been convincingly shown to be associated with repeated exposure to chlorhexidine. Proposed mechanisms include drug inactivation, efflux, and decreased uptake. ...