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I N F E C T I O N
P R E V E N T I O N
the downside of it? There probably is not a major downside to it."
The benefits of CHG
Antiseptic showers are particularly effective if CHG is used. Studies show it has
a greater effect on reducing skin microbial colony counts than povidone-iodineand triclocarban-medicated soaps,2, 5, 10 and while its effect is not as immediate
as alcohol's, it has a longer residual effect.5 (Incidentally, non-medicated soap
has been found in some cases to increase the amount of bacteria on the skin.1,
2)
"The use of CHG in a pre-op shower depopulates the patient, and it's the gift
that keeps on giving," says Allan Morrison, MD, MSc, a hospital epidemiologist
for Alexandria, Va.-based Inova Health System.
It's a unique ability, he says. The epidermis is made up of 7 different cell
layers, with about 80 percent of resident and transient flora residing in the
top five. To maintain a lasting antimicrobial effect, he says, "you have to have
a product that penetrates deeply into the layers — CHG appears to do that —
and one that can't be deactivated. Iodine, in comparison, can be inactivated
by exposure to protein-laden material, such as blood or tissue interstitial fluids."
But for a CHG product to achieve its greatest effect, it has to be used properly. "That's where the variability lies," says Ms. Greene. "How does the patient
apply it? Does she even use it?" If pre-op antiseptic showers are taken in the
uncontrolled environment of a patient's home, she says, it is difficult to enforce
the antiseptic's proper use. And if the product is simply squirted on, then quickly
washed off, its effect may be scarce.
Antiseptic intervention
That's why patient education is critical. Identify the patient's point of entry into
the surgical process, whether that's a visit to a physician's office or a pre-op
screening, and give the patient clear, concise directions for CHG showering
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