Antimicrobial efficacies of chlorhexidine gluconate–alcohols and a povidone–iodine solution as skin preparations in vivo
Yutaka Nishihara A C , Takumi Kajiura A , Katsuhiro Yokota A , Hiroyoshi Kobayashi B and Takashi Okubo B
+ Author Affiliations
- Author Affiliations
A Yoshida Pharmaceutical Company Ltd, Research & Development Division, Tokyo, Japan.
B Tokyo Healthcare University, Postgraduate School, Tokyo, Japan.
C Corresponding author. Email: nishihara_yutaka@yoshida-pharm.co.jp
Healthcare Infection 17(2) 52-56 https://doi.org/10.1071/HI12006
Submitted: 14 February 2012 Accepted: 11 April 2012 Published: 22 May 2012
Abstract
The main purpose of the study was to compare the antimicrobial efficacy of chlorhexidine gluconate (CHG)–alcohols and a povidone–iodine (PVP–I) solution on the skin. The efficacy on the antecubital fossa, the abdomen and the inguen was evaluated to a maximum of 24 h after treatment by testing 74 healthy adult subjects according to an ASTM standard method. Relative to baseline microbial populations, all products produced significant reductions in population at all sites (P < 0.05). A blocked, two-factor ANOVA showed that the performance (mean log10 reduction values) on inguinal sites at 24 h (2.63 for 1% CHG–ethanol, 3.25 for 2% CHG–isopropanol preparation and 2.29 for PVP–I solution) was not significantly different at any time after treatment (P > 0.05); this applied equally at the other sites tested. Given that Japanese pharmaceutical regulations limit CHG content in antiseptics to a maximum of 1%, it would be reasonable to expect that a 1% CHG–ethanol skin preparation could be chosen in Japan that would perform well and have promising potential for catheter preparation and/or maintenance preparation.
Additional keywords: catheter-related bloodstream infection, CDC Guidelines, CRBSI, skin preparation.
References
[1] Garibaldi RA, Skolnick D, Lerer T, Poirot A, Graham J, Krisuinas E, et al The impact of preoperative skin disinfection on preventing intraoperative wound contamination. Infect Control Hosp Epidemiol 1988; 9 109–13.| The impact of preoperative skin disinfection on preventing intraoperative wound contamination.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1c7ntVKqtg%3D%3D&md5=bbee71720ad60d6e99d3caed4ea4fef3CAS |
[2] Crosby CT, Mares AK. Skin antisepsis: past, present and future. J Vasc Access Devices 2001; 6 26–31.
| Skin antisepsis: past, present and future.Crossref | GoogleScholarGoogle Scholar |
[3] Food and Drug Administration Tentative Final Monograph for Health-Care Antiseptic Drug Products; Proposed Rules. Fed Regist 1994; 59 31401–52.
[4] Paulson DS. Handbook of Topical Antimicrobials. Industrial Applications in Consumer Products and Pharmaceuticals. New York: Marcel Dekker; 2003.
[5] O’Grady NP, Alexander M, Patchen Dellinger E, Gerberding JL, Heard SO, Maki DG, et al Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002; 23 759–69.
| Guidelines for the prevention of intravascular catheter-related infections.Crossref | GoogleScholarGoogle Scholar |
[6] O’Grady NP, Alexander M, Burns LA, Patchen Dellinger E, Garland J, Heard SO, et al. CDC Guideline for the Prevention of Intravascular Catheter-Related Infections. Atlanta, GA: Centers for Disease Control and Prevention; 2011. Available from: http://www.cdc.gov/hicpac/BSI/BSI-guidelines-2011.html [verified 26 April 2012].
[7] Nihon Seiyaku Dantai Rengokai. Iryoyou-Iyakuhin Saihyouka no Goannai. 1985; 24: 3739 [in Japanese].
[8] ASTM standard E1173-01. Standard Test Method for Evaluation of Preoperative, Precatheterization, or Preinjection Skin Preparations. ASTM International: West Conshohocken, PA; 2009.
[9] ASTM Standard E1054-08. Standard Test Method for Evaluation of Preoperative, Precatheterization, or Preinjection Skin Preparations. ASTM International: West Conshohocken, PA; 2008.
[10] Holtz TH, Wenzel RP. Post discharge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control 1992; 20 206–13.
| Post discharge surveillance for nosocomial wound infection: a brief review and commentary.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK38zpvVWhsA%3D%3D&md5=5f6e046c1683d533715a28a7224f440dCAS |
[11] Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004; 17 863–93.
| Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs.Crossref | GoogleScholarGoogle Scholar |
[12] Lilly HA, Lowbury EJL, Wilkins MD. Detergents compared with each other and with antiseptics as skin “degerming” agents. J Hyg (Lond) 1979; 82 89–93.
| Detergents compared with each other and with antiseptics as skin “degerming” agents.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE1M7htVGluw%3D%3D&md5=eb5787d9e6197f8fa58ebd0cb0c9b043CAS |
[13] Pottinger JM, Starks SE, Steelman VM. Skin preparation. Perioper Nurs Clin 2006; 1 203–10.
| Skin preparation.Crossref | GoogleScholarGoogle Scholar |
[14] Kampf G, Ostermeyer C, Heeg P, Paulson DS. Evaluation of two methods of determining the efficacies of two alcohol-based hand rubs for surgical hand antisepsis. Appl Environ Microbiol 2006; 72 3856–61.
| Evaluation of two methods of determining the efficacies of two alcohol-based hand rubs for surgical hand antisepsis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28XmtV2gsbY%3D&md5=ae66800ae337b01390e77d4a4dbba87fCAS |
[15] Paulson D. Hand scrub products – performance requirements versus clinical relevance. AORN J 2004; 80 225–34.
| Hand scrub products – performance requirements versus clinical relevance.Crossref | GoogleScholarGoogle Scholar |
[16] Rotter M, Sattar S, Dharan S, Allegranzi B, Mathai E, Pittet D. Methods to evaluate the microbial activities of hand-rub and hand-wash agents. J Hosp Infect 2009; 73 191–9.
| Methods to evaluate the microbial activities of hand-rub and hand-wash agents.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1Mnpslalug%3D%3D&md5=ffc08826e2203b315c2d226e07af87b7CAS |
[17] Maki DG, Knasinski V, Narans LL. A Randomized Trial of a Novel 1% Chlorhexidine–75% Alcohol Tincture vs. 10% Povidone–Iodine for Cutaneous Disinfection with Vascular Catheters. Toronto: Society for Healthcare Epidemiology of America; 2001.
[18] Humar A, Ostromecki A, Direnfeld J, Marshal JC, Lazar N, Houston PC, et al Prospective randomized trial of 10% povidone–iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection. Clin Infect Dis 2000; 31 1001–7.
| Prospective randomized trial of 10% povidone–iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3cXos1yrtrc%3D&md5=83722b642b2f55d7057d3fcfeea0bd47CAS |
[19] Vallés J, Fernandez I, Alcaraz D, Chacón E, Carzorla A, Canals M, et al Prospective randomized trial of 3 antiseptic solutions for prevention of catheter colonization in an intensive care unit for adult patients. Infect Control Hosp Epidemiol 2008; 29 847–53.
| Prospective randomized trial of 3 antiseptic solutions for prevention of catheter colonization in an intensive care unit for adult patients.Crossref | GoogleScholarGoogle Scholar |
[20] Reichel M, Heisig P, Kohlmann T, Kampf G. Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob Agents Chemother 2009; 53 4778–82.
| Alcohols for skin antisepsis at clinically relevant skin sites.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXhtl2itLbI&md5=0da92b4b83d8c00bb8a94bbc6edaf86dCAS |
[21] Hibbard JS, Mulberry GK, Brady AR. A clinical study comparing the skin antisepsis and safety of chloraprep, 70% isopropyl alcohol, and 2% aqueous chlorhexidine. J Infus Nurs 2002; 25 244–9.
| A clinical study comparing the skin antisepsis and safety of chloraprep, 70% isopropyl alcohol, and 2% aqueous chlorhexidine.Crossref | GoogleScholarGoogle Scholar |
[22] Leyden JJ, McGinley KJ, Foglia AN, Wahrman JE, Gropper CN, Vowels BR. A new method for in vivo evaluation of antimicrobial agents by translocation of complex dense populations of cutaneous bacteria. Skin Pharmacol 1996; 9 60–8.
| A new method for in vivo evaluation of antimicrobial agents by translocation of complex dense populations of cutaneous bacteria.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DyaK28Xit1Gmu7s%3D&md5=a456fdbe68a335a40de0189e451d2c91CAS |
[23] Maki DG, Ringer M, Alvarado CJ. Prospective, randomized trial of povidone–iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991; 338 339–43.
| Prospective, randomized trial of povidone–iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3MzhvVynug%3D%3D&md5=57db970416aafcf5f15d8e486461bb04CAS |
[24] Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S. Chlorhexidine compared with povidone–iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002; 136 792–801.
| 1:CAS:528:DC%2BD38XkvFShsL0%3D&md5=38a21baa3b8222d996d9c145daeab8e6CAS |
[25] Darouiche R, Wall M, Itani M, Itani KMF, Otterson MF, Webb AL, et al Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. N Engl J Med 2010; 362 18–26.
| Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXjvFGnsA%3D%3D&md5=b8d39a6be5b744a542334da6a3573e0cCAS |
[26] Swenson BR, Hendrick TL, Metzger R, Bonatti H, Pruett TL, Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: A prospective study of 3 skin preparation protocols. Infect Control Hosp Epidemiol 2009; 30 964–71.
| Effects of preoperative skin preparation on postoperative wound infection rates: A prospective study of 3 skin preparation protocols.Crossref | GoogleScholarGoogle Scholar |
[27] Tanimura H, Okubo T. Antisepsis effect of insertion site of central venous catheter. Jpn J Environ Infect 2010; 25 281–5. [in Japanese].
| Antisepsis effect of insertion site of central venous catheter.Crossref | GoogleScholarGoogle Scholar |