An alcohol-based hand hygiene product containing chlorhexidine gluconate was more effective than another product containing ethanol alone, according to recent data.
“Our findings are consistent with previous studies demonstrating that the persistent antimicrobial activity of [chlorhexidine gluconate (CHG)] may be beneficial in reducing bacterial contamination on hands up to several hours after application,” Abhishek Deshpande, MD, PhD, of the department of infectious diseases at Cleveland Clinic’s Medicine Institute, and colleagues wrote in Infection Control & Hospital Epidemiology.
Health care workers’ hands are considered a significant source of hospital-acquired infections and account for an estimated 20% to 40% of device-related nosocomial infections, according to the researchers. Alcohol-based hand sanitizers are recommended before and after patient contact to reduce the risk for infection. CHG is used in some hand sanitizers because of its broad-spectrum activity against gram-positive and gram-negative bacteria, yeasts and enveloped viruses. Last year, however, the FDA issued a safety announcement warning that although rare, the number of reports of serious allergic reactions to skin antiseptic products containing CHG have increased over the past several years. From January 1969 to June 2015, the FDA was notified of 43 cases of anaphylaxis, a severe form of allergic reaction, with the use of gluconate products. More than half of these cases occurred after 2010.
For their study, Deshpande and colleagues compared the immediate and persistent activity of Avagard (3M), which contains ethanol plus CHG, and Purell Advanced Foam (Gojo), which contains ethanol only. The researchers randomly assigned 51 health care workers to apply either product while working in an ICU at a large teaching hospital. After a 3-day washout period, the participants tested the alternative product. The researchers determined the products’ efficacy by measuring the amount of aerobic colony-forming units (CFUs) on hand prints that were obtained immediately after participants applied the hand sanitizer and again after spending 4 to 7 minutes in ICU common areas.
The data showed that ethanol plus CHG was associated with significantly lower aerobic bacterial counts immediately after use (0.27 ± 0.05 log CFU vs. 0.88 ± 0.08 log CFU; P = 0.035) and several minutes later (1.87 ± 0.07 log CFU vs. 2.17 ± 0.05 log CFU; P < .0001) compared with ethanol alone. No antibiotic-resistant organisms were found immediately after sanitizer use. However, after spending time in the ICU common areas, one MRSA isolate and two fluoroquinolone-resistant gram-negative bacteria isolates were identified in the ethanol plus CHG group, and five MRSA isolates and three fluoroquinolone-resistant gram-negative bacteria isolates were identified in the ethanol-only group.
Both products were well-tolerated, with no reports of increased skin irritation or dryness, according to the researchers. They concluded that future investigations with longer periods of follow-up are needed to confirm whether CHG-containing sanitizers have sustained antimicrobial protection against health care-associated pathogens.
“It should be acknowledged that there is considerable debate regarding the value of adding CHG to alcohol-based surgical scrubs and hand sanitizers, including the potential for developing acquired resistance to CHG,” they added. “Additional studies are needed to provide a more complete assessment and understanding of the risks and benefits of this approach in ICUs and high-risk patient areas.” – by Stephanie Viguers
Deshpande A, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2017.293.
FDA. FDA Drug Safety Communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. https://www.fda.gov/Drugs/DrugSafety/ucm530975.htm. Accessed February 2, 2018.
Disclosures: Deshpande reports receiving research funding from 3M, Clorox and Steris. Please see the study for all other authors’ relevant financial disclosures.