title: Pitfalls in efficacy testing--how important is the validation of neutralization of chlorhexidine digluconate?
abstract: BACKGROUND
  Effective neutralization of active agents is essential to obtain valid efficacy results, especially when non-volatile active agents like chlorhexidine digluconate (CHG) are tested. The aim of this study was to determine an effective and non-toxic neutralizing mixture for a propan-1-ol solution containing 2% CHG.
  
  
  METHODS
  Experiments were carried out according to ASTM E 1054-02. The neutralization capacity was tested separately with five challenge microorganisms in suspension, and with a rayon swab carrier. Either 0.5 mL of the antiseptic solution (suspension test) or a saturated swab with the antiseptic solution (carrier test) was added to tryptic soy broth containing neutralizing agents. After the samples were mixed, aliquots were spread immediately and after 3 h of storage at 2 - 8 degrees C onto tryptic soy agar containing a neutralizing mixture.
  
  
  RESULTS
  The neutralizer was, however, not consistently effective in the suspension test. Immediate spread yielded a valid neutralization with Staphylococcus aureus, Staphylococcus epidermidis and Corynebacterium jeikeium but not with Micrococcus luteus (p < 0.001) and Candida albicans (p < 0.001). A 3-h storage period of the neutralized active agents in suspension resulted in significant carry-over activity of CHG in addition against Staphylococcus epidermidis (p < 0.001) and Corynebacterium jeikeium (p = 0.044). In the carrier test, the neutralizing mixture was found to be effective and non toxic to all challenge microorganisms when spread immediately. However, after 3 h storage of the neutralized active agents significant carry-over activity of CHG against Micrococcus luteus (p = 0.004; Tukey HSD) was observed.
  
  
  CONCLUSIONS
  Without effective neutralization in the sampling fluid, non-volatile active ingredients will continue to reduce the number of surviving microorganisms after antiseptic treatment even if the sampling fluid is kept cold straight after testing. This can result in false-positive antiseptic efficacy data. Attention should be paid during the neutralization validation process to the amount of antiseptic solution, the storage time and to the choice of appropriate and sensitive microorganisms.
authors.affiliation: Bode Chemie GmbH & Co, KG, Scientific Affairs, Melanchthonstr, 27, 22525, Hamburg, Germany. mirja.reichel@bode-chemie.de
authors.forename: Mirja
authors.initials: M
authors.lastname: Reichel
authors.forename: Peter
authors.initials: P
authors.lastname: Heisig
authors.forename: Günter
authors.initials: G
authors.lastname: Kampf
mesh_terms: D000891:Anti-Infective Agents, Local / Q000037:antagonists & inhibitors* / Q000494:pharmacology*; D001431:Bacteriological Techniques / Q000379:methods*; D002176:Candida albicans / Q000187:drug effects; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors / Q000494:pharmacology; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006801:Humans; D008826:Microbial Sensitivity Tests; D009172:Mycology / Q000379:methods*; D012867:Skin / Q000382:microbiology; D013048:Specimen Handling / Q000379:methods*
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine