title: A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5% w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting.
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.
authors.affiliation: Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Casey
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Abdul
authors.initials: A
authors.lastname: Itrakjy
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Chrissie
authors.initials: C
authors.lastname: Birkett
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Clethro
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Bonser
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Graham
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mascaro
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Domenico
authors.initials: D
authors.lastname: Pagano
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rooney
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Wilson
authors.affiliation: Wolfson Computer Laboratory, University Hospitals Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.affiliation: CareFusion Corporation, San Diego, CA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Crosby
authors.affiliation: 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.
authors.forename: Thomas
authors.initials: T
authors.lastname: Elliott
mesh_terms: D019840:2-Propanol / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000985:Antisepsis / Q000379:methods*; D058491:Bacterial Load; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000379:methods; D004202:Disinfectants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012501:Saphenous Vein / Q000601:surgery; D012867:Skin / Q000382:microbiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D004202:Disinfectants; C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine
keywords: Skin antisepsis; Surgical site infection