Application of antiseptic products to the skin plays an important role in prevention
of a variety of health care–associated infections. Preoperative bathing or showering
is widely recommended to reduce the risk of surgical site infections. Evidence of
the impact of this measure on surgical site infection rates is mixed, and further
prospective trials comparing standardized protocols for showering with plain soap
or chlorhexidine gluconate (CHG)-containing soap, or bathing with 2% CHG-impregnated
cloths are needed to establish the most effective approach. Current evidence favors
the use of alcohol-containing solutions, often containing CHG or povidone-iodine,
for surgical site preparation of the skin. Preparation of vaginal mucosa prior to
gynecologic surgery may be performed using either povidone-iodine or CHG. Surgical
hand antisepsis can be performed by scrubbing with an antimicrobial soap or by handrubbing
using an alcohol-based handrub. Addition of CHG to alcohol-based handrubs intended
for surgical hand antisepsis is not necessary if they meet recommended efficacy criteria.
Daily CHG bathing of intensive care unit patients has been shown to reduce a variety
of health care–associated infections, most commonly bloodstream infections (BSIs).
Achieving and maintaining optimum application protocols may be challenging, suggesting
the need for ongoing staff education, monitoring, and feedback. Additional studies
are needed to determine the impact of daily CHG bathing of non-intensive care unit
patients. Alcoholic CHG is currently the preferred antiseptic for skin preparation
prior to insertion of central and arterial intravascular catheters. CHG-impregnated
dressings have been shown to reduce catheter-associated BSI. Because of the widespread
use of antiseptics, especially CHG, surveillance for emergence of increased tolerance
or resistance is warranted.
Antiseptics are applied to the skin for a variety of purposes in health care. Common
scenarios in which topical antiseptics are used include preoperative bathing, surgical
site preparation, surgical hand hygiene, daily bathing of intensive care unit patients,
and prevention of intravascular catheter-associated BSI. The purpose of this article
is to review recent evidence regarding the best products for skin antisepsis.
Key Words
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Article Info
Footnotes
Conflicts of interest: J.M.B. is a consultant to and has received travel support from Diversey and GOJO Industries. He has received an honorarium from Sodexo.
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© 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
