title: Preadmission Application of 2% Chlorhexidine Gluconate (CHG): Enhancing Patient Compliance While Maximizing Skin Surface Concentrations.
abstract: OBJECTIVE
  Surgical site infections (SSIs) are responsible for significant morbidity and mortality. Preadmission skin antisepsis, while controversial, has gained acceptance as a strategy for reducing the risk of SSI. In this study, we analyze the benefit of an electronic alert system for enhancing compliance to preadmission application of 2% chlorhexidine gluconate (CHG).
  
  
  METHODS
  Following informed consent, 100 healthy volunteers in an academic, tertiary care medical center were randomized to 5 chlorhexidine gluconate (CHG) skin application groups: 1, 2, 3, 4, or 5 consecutive applications. Participants were further randomized into 2 subgroups: with or without electronic alert. Skin surface concentrations of CHG (μg/mL) were analyzed using a colorimetric assay at 5 separate anatomic sites.
  
  
  METHODS
  Preadmission application of chlorhexidine gluconate, 2%
  
  
  RESULTS
  Mean composite skin surface CHG concentrations in volunteer participants receiving EA following 1, 2, 3, 4, and 5 applications were 1,040.5, 1,334.4, 1,278.2, 1,643.9, and 1,803.1 µg/mL, respectively, while composite skin surface concentrations in the no-EA group were 913.8, 1,240.0, 1,249.8, 1,194.4, and 1,364.2 µg/mL, respectively (ANOVA, P<.001). Composite ratios (CHG concentration/minimum inhibitory concentration required to inhibit the growth of 90% of organisms [MIC90]) for 1, 2, 3, 4, or 5 applications using the 2% CHG cloth were 208.1, 266.8, 255.6, 328.8, and 360.6, respectively, representing CHG skin concentrations effective against staphylococcal surgical pathogens. The use of an electronic alert system resulted in significant increase in skin concentrations of CHG in the 4- and 5-application groups (P<.04 and P<.007, respectively).
  
  
  CONCLUSIONS
  The findings of this study suggest an evidence-based standardized process that includes use of an Internet-based electronic alert system to improve patient compliance while maximizing skin surface concentrations effective against MRSA and other staphylococcal surgical pathogens.
authors.affiliation: 1Department of Surgery (Division of Vascular Surgery),Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Edmiston
authors.affiliation: 1Department of Surgery (Division of Vascular Surgery),Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Candace J
authors.initials: CJ
authors.lastname: Krepel
authors.affiliation: 3Infection Prevention Consultants,Boston,Massachusetts.
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Spencer
authors.affiliation: 4Department of Surgery,Pernambuco University,Recife,Brazil.
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Ferraz
authors.affiliation: 1Department of Surgery (Division of Vascular Surgery),Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Seabrook
authors.affiliation: 1Department of Surgery (Division of Vascular Surgery),Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Cheong J
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: 1Department of Surgery (Division of Vascular Surgery),Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lewis
authors.affiliation: 1Department of Surgery (Division of Vascular Surgery),Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Kellie R
authors.initials: KR
authors.lastname: Brown
authors.affiliation: 1Department of Surgery (Division of Vascular Surgery),Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Rossi
authors.affiliation: 1Department of Surgery (Division of Vascular Surgery),Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Malinowski
authors.affiliation: 2Surgical Microbiology Research Laboratory,Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Edmiston
authors.affiliation: 4Department of Surgery,Pernambuco University,Recife,Brazil.
authors.forename: Edmundo M
authors.initials: EM
authors.lastname: Ferraz
authors.affiliation: 5Institute of Skin Integrity and Infection Prevention,University of Huddersfield,Huddersfield,United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Leaper
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D000985:Antisepsis / Q000379:methods*; D001494:Baths; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D010349:Patient Compliance; D011300:Preoperative Care / Q000379:methods*; D012867:Skin / Q000187:drug effects; D013210:Staphylococcus / Q000187:drug effects; D013530:Surgical Wound Infection / Q000517:prevention & control*; D062606:Tertiary Care Centers
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine