Preoperative Shower Revisited: Can High Topical Antiseptic Levels be
Achieved on the Skin Surcface Before Surgical Admission?
By
Charles E Edmiston Jr, PhD, Candace J Krepel, MS, Gary R. Seabrook, MD, FACS, Brian D Lewis, MD,
FACS, Kellie R Brown, MD, FACS, Jonathan B Towne, MD, FACS
Published In
Journal of the American College of Surgeons – May 2008
OBJECTIVE:
COMPARE CHG SKIN CONCENTRATIONS OF 2% CHG CLOTHS VS 4% CHG SOAP SOLUTION
KEY SALES TAKE AWAYS:

Skin antisepsis is a sentinel strategy for reducing risk of SSI’s.

Group A = 4% CHG Solution (using clean cloth apply twice, wait 2 minutes, then rinse)

Group B = 2% CHG Cloth (shower, towel dry, then apply (3) 2% CHG Cloths for 2 minutes)

3 Randomized Test Groups for Both A & B:
1. Group 1: Evening Application
2. Group 2: Morning Application
3. Group 3: Evening & Morning Application

CHG skin concentration measurements were taken from 5 body parts:
1. Left Elbow, Right Elbow, Abdominal, Left Knee, Right Knee

5 Subjects reported an adverse event, 3 with 4% CHG Solution & 2 with 2% CHG Cloth.

Results:
1. 2% CHG Cloth resulted in higher CHG skin concentrations: 12 – 27 times!
2. 4% CHG Solution had gaps in CHG antimicrobial activity on skin.
3. 2% CHG Cloth had NO gaps in CHG antimicrobial activity on skin.

Discussion:
1. System approach to SSI prevention requires marriage of advance preoperative skin
preparation with final OR skin preparation.
2. The activity of CHG is diluted in the process of rinsing (4% CHG Solution)
3. The polyester cloth is more efficient at exfoliating the skin surface, allowing greater
penetration of CHG to the deeper recesses of the skin.
HOW TO POSITION WITH PRODUCT :
 The first physician peer-reviewed journal article comparing 2% CHG Cloth v 4% CHG Solution
 This study establishes the need for advanced preoperative skin antisepsis
 Demonstrates that 2% CHG Cloth leaves more CHG on the skin, which translates into more
protection for patient against the SSI causing pathogens.
 Use to disarm current process of using 4% CHG Solution, while demonstrating the efficacy of
our 2% CHG Cloth.
QUESTIONS TO ENGAGE STUDY:

What quality initiatives have you put in place to address the prevention of SSI’s? What drove
the implementation of those practices?

What is the goal in performing advanced preoperative skin prep?

The study shows skin coverage gaps in anti-microbial activity, how do ensure your current
process of 4% CHG Solution has no gaps?

How do (would) instruct your patients to prep their skin using a 4% CHG Solution? What %
would follow these directions properly?

How do (would) instruct your patients to prep their skin using a 2% CHG Cloth? What %
would follow these directions properly?

Comparing the 2 processes, what process is easier to educate patients on using & easier for
patient to use and be compliant with?