INFECTION PREVENTION
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the August issue of the Journal of the American College of Surgeons,
they asked 80 volunteers to shower with 4% chlorhexidine gluconate
liquid soap over the course of 2 or 3 days. Half of the volunteers were
prompted to shower by text messages sent to their mobile phones.
The researchers found that those who'd received the texts had sig-
nificantly higher skin-surface concentrations of CHG — about two-
thirds more — than the unprompted volunteers. They also had less of
the soap left over at the end of the study (
tinyurl.com/njpwvmz
).
"This is a patient-centric process. We have to have a strategy in
place to remind them to complete the process," says Charles E.
Edmiston Jr., PhD, CIC, professor of surgery, director of the college's
Surgical Microbiology Research Laboratory and the study's lead
author. Text messaging has previously been used to help patients take
medications on time, but "it's a natural to apply it to pre-surgical
preparation."
While timing and repetition are important, they're only a part of the
compliance that's necessary. Surgical patients should be provided
with the soap or wipes, as well as oral and written directions explain-
ing precisely how much to use and to wait 60 seconds before rinsing
it off. "You want to have a high, sustainable concentration on the
skin," says Dr. Edmiston, given CHG's cumulative effect and residual
antimicrobial activity.
Would the use of 2% CHG-impregnated wipes after a shower, which
aren't followed by rinsing, create a more standardized and effective
process? "That's a question I hope to answer in the future," he says.
A patient's responsibility
In the absence of hard scientific evidence, and in light of the potential
payoff, experts see pre-op bathing as a clinical responsibility that's in
patients' hands.
