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Chlorhexidine gluconate showers

AORN Journal, Jan, 2008 by Sharon Giarrizzo-Wilson

QUESTION: Our hospital is instructing patients to take two showers with chlorhexidine gluconate (CHG) before surgery. Does AORN make recommendations regarding this practice? What patient instructions should be provided?

ANSWER: Currently, AORN is developing guidance related to CHG showers that will be included in the 2008 edition of AORN's Standards, Recommended Practices, and Guidelines. AORN is incorporating the use of CHG as a preoperative showering agent based on the strength of evidence in the literature and recommendations by the Centers for Disease Control and Prevention (1,2) and the Association of Professionals in Infection Control and Epidemiology. (3,4)

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Research strongly demonstrates the efficacy of 4% CHG showers in reducing the microbial load on preoperative patients. (1,5-10) Showering with 4% CHG has proven to be more effective than povidone iodine or soap (ie, medicated or plain) in reducing microbial counts on the skin. More than one shower, however, is necessary to achieve maximum antiseptic effectiveness. (7,8)

Unless contraindicated, patients undergoing clean surgical procedures (ie, surgical wound classification I), should receive instructions to perform two preoperative showers using 4% CHG. Following each shower, the patient should:

* thoroughly rinse the skin;

* dry using a clean, dry towel; and

* don clean clothing.

Patients also should be cautioned to prevent CHG from coming in contact with the eyes and to avoid getting it into the ear canal or onto other mucus membranes.

Washing and rinsing is the first defense in removing microorganisms from the skin. Despite this action, some organisms may be more difficult or impossible to kill. Preoperative showering with 4% CHG is an effective measure to reduce skin microbial colonization and reduce the risk of subsequent contamination of the surgical wound.

REFERENCES

(1.) Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999; 20(4):250-278.

(2.) HICPAC meeting minutes, May 22-23, 2000. Centers for Disease Control and Prevention. Healthcare Infection Control Practices Advisory Committee. http://www.cdc.gov/maso/FACM/pdfs/HICPAC/20000522%20HICPAC%20minutes.pdf. Accessed October 25, 2007.

(3.) Church NB. Surgical services. In: APIC Text of Infection Control and Epidemiology. 2nd ed. Washington, DC: Association for Professionals in Infection Control and Epidemiology, Inc; 2005:46-1-14.

(4.) EPI:201, Infection prevention in surgical settings and surgical populations. Association for Professionals in Infection Control and Epidemiology. http://www.apic.org/AM/Template.cfm?Section=Search& section=EPI201&template= /CM/ContentDisplay.cfm&ContentFileID=7832. Accessed October 25, 2007.

(5.) Leigh DA, Stronge JL, Marriner J, Sedgwick J. Total body bathing with 'Hibiscrub' (chlorhexidine) in surgical patients: a controlled trial. J Hosp Infect. 1983;4(3):229-235.

(6.) Kluytmans JA, Mouton JW, Ijzerman EP, et al. Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis. 1995;16(3):216-219.

(7.) Hayek LJ, Emerson JM, Gardner AM. A placebo-controlled trial of the effect of two preoperative baths or showers with chlorhexidine detergent on postoperative wound infection rates. J Hosp Infect. 1987;10(2):165-172.

(8.) Garibaldi RA. Prevention of intraoperative wound contamination with chlorhexidine shower and scrub. J Hosp Infect. 1988;11(Suppl B):5-9.

(9.) Byrne DJ, Napier A, Phillips G, Cuschieri A. Effects of whole body disinfection on skin flora in patients undergoing elective surgery. J Hosp Infect. 1991;17(3):217-222.

(10.) Kaiser AB, Kemodle DS, Barg NL, Petracek MR. Influence of preoperative showers on staphylococcal skin colonization: a comparative trial of antiseptic skin cleansers. Ann Thorac Surg. 1988;45(1):35-38.

SHARON GIARRIZZO-WILSON

RN, MS, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE

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Chlorhexidine gluconate showers

AORN Journal, Jan, 2008 by Sharon Giarrizzo-Wilson

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