What is the difference between chlorhexidine and betadine

In another study, the chance of obtaining C. In addition, C. Thus, the anaerobic skin flora represents a major challenge for skin antisepsis. Lee et al. Experiments with excised human skin in diffusion chambers showed that CHG penetrates relatively poorly into deep skin layers [ 23 ], while iodine released from povidone PVP molecules possesses substantially better penetration capabilities and penetrates through full-thickness skin in relevant concentrations in a time-dependent fashion [ 24 ].

Although PVP-I in contrast to CHG has no appreciable residual antimicrobial effect [ 25 ], it exerts a long-lasting effectiveness on skin due to the delayed release of iodine from PVP-I by a second-order reaction. The aim of this work was to conduct a study with healthy volunteers, following similar procedures as outlined by the US Food and Drug Administration FDA and the American Society for Testing and Materials ASTM [ 26 , 27 , 28 , 29 ], but modified to test the effects on both aerobic and anaerobic skin flora after standard and prolonged application times on the shoulder region.

This study was conducted using a randomized cross-over design with participation of 16 healthy volunteers, 9 female and 7 male healthy individuals of Caucasian background and an average age of The application was carried out on both shoulders, using two separate shoulder areas for sampling immediate and 3-h values on the antero-lateral site of each shoulder on each day Fig.

Participants were randomized by drawing opaque folded paper tickets from a container, such that two different antiseptic treatments per day were represented in a cross-over design, and each volunteer completed four different treatments. The sampled skin area is marked in green on a right male shoulder.

Most of the incisional regions in arthroscopic and open shoulder surgery are included within this area. Exclusion criteria were macroscopically visible lesions of the skin except acne juvenilis, infections of the shoulder areas, dermatosis except acne, participation in another study within the last 30 days, pregnancy, lactation, thyroid disorders, intolerance to CHG or iodine, age under 18, therapy with radioactive iodine, antiseptic procedures on the designated areas within in the last 7 days and systemic antibiotics within the last 7 days.

Two female volunteers suffered from active acne juvenilis at the shoulder areas that was less pronounced in the face; this was confirmed dermatologically. The preparation without applicators was necessary for the min application, in order to keep the skin areas moist with soaked dressings for 30 min.

Microbial skin counts were obtained before antiseptic application pre-values , after application and air-drying of the sampling site immediate post-values , and 3 h after treatment 3-h post-values. A first 10 —1 dilution was prepared by adding 0. After 5 min neutralization in the first 10 —1 dilution, further dilutions of 10 —2 and 10 —3 were prepared in the respective neutralization solution, and 0.

The anaerobic atmosphere was generated in anaerobic jars using Anaerocult A sachets Merck, Darmstadt, Germany. After aerobic incubation, the colony forming units CFU were counted and a representative sample of colonies was picked for identification, such that at least one colony of each morphologically different colony type was tested.

For uniformity of measurements, we converted the numbers of colonies counted to CFU per 5 cm 2 of skin and expressed these as log 10 values. Then, we calculated the reduction factors RFs as the differences between the log 10 pre-values and the log 10 post-values. To calculate the reduction factors and transform to log 10 , plates without growth were set to a value of 1.

Skin bacteria from five volunteers were collected by the cup-scrub technique [ 30 ] and pooled. Using the methodology of ASTM E [ 31 ], pooled bacteria were used to verify the effectiveness of Lipofundin to inactivate CHG, of sodium thiosulfate to diminish the oxidizing agent iodine, and to ensure that the inactivation solutions did not significantly influence the bacterial counts, quantitatively and qualitatively.

Final concentrations of 0. The concentration of the active agent was calculated using the treated skin area of cm 2 Finally, an area of 2. Lipofundin containing 1. Similar results were obtained in tests of neutralizer effectiveness, neutralizer toxicity and organism viability under aerobic and anaerobic culture conditions, using test solutions containing the residual antimicrobial agent which were derived from volunteers after skin antisepsis.

Therefore, it was ascertained that CHG or PVP-I were effectively inactivated by the respective neutralization solutions without influencing bacterial growth after aerobic and anaerobic incubation. Mann—Whitney and Wilcoxon tests were calculated.

Effect sizes i. Based on a required power of 0. All volunteers received a questionnaire for self-assessment of skin tolerability to evaluate the following parameters on an analogue scale from 1 to In case of skin irritation, volunteers were asked to contact the investigators to have the nature of the irritation evaluated, and if necessary, to obtain treatment.

The skin antiseptics were well tolerated after 2. None of the volunteers reported any of the five listed adverse events on the skin tolerability scale. The validity of the cross-over design was confirmed by a comparison of the pre-values on day 1 and day 4. There was no significant difference mean log value day 1 aerobically, 2.

In addition, S. None of the samples collected after 3 h yielded CNS. The majority of the bacteria on anaerobic plates were C. Only a negligible number of other anaerobic species were recovered and a few anaerobic cultures yielded CNS.

When looking at the short 2. However, we consider this single significant value a likely experimental outlier, because the log pre-values for the 2. No growth at all was observed in 60 of 64 immediate post-values and in 49 of 64 3-h post-values. The relative improvement of performance of CHG-ALC after prolonged application and late sampling appears consistent with the relatively slow skin penetration kinetics of CHG [ 23 ].

This is consistent with findings from an earlier study in which CNS were frequently detected in the surgical field after 3 min of preoperative skin antisepsis with CHG-ALC unpublished findings. These data underscore the need for protection against CNS in surgery by potent antisepsis. More pronounced differences between the antiseptic compounds became apparent when tested against the anaerobic skin flora. On the other hand, no relevant statistically significant differences were observed in any comparisons of the same agents between 2.

Our results are in line with a clinical trial that compared the treatment of abdominal incision sites [ 34 ]. In this trial, 0. Another trial comparing 0. However, on secondary endpoint analysis, skin antisepsis with CHG-ALC was associated with significantly higher odd ratios for overall SSI, including prosthetic joint infection [ 35 ].

In another trial, skin antisepsis with 7. The shoulder region was chosen as test area because it is known to be colonized with C. The standard method for preoperative skin antisepsis consists of treating the skin with either an applicator or with forceps and gauze for 30 s, followed by keeping the skin moist with the antiseptic for 2 min. The efficacy of both application methods is similar [ 40 ]. It is considered beneficial to use an extended contact time on skin areas that have a high density of sebaceous glands [ 41 ].

The contact time of 30 min in the present study was chosen because we reasoned that with an extended contact time, the deep skin flora would be targeted more effectively. If confirmed, this would have considerable implications for antiseptic preparation of the shoulder area.

Indeed, after a contact time of It is thought that the physiological flora of the human skin is regenerated completely after 3 days, because the re-colonization starts about 60 min after alcohol-based skin antisepsis [ 42 ]. After 24 h, the skin flora is nearly completely regenerated [ 43 ]. Thus, the study was performed as a crossover study with an interval of 3 days between the tests. In line with our hypothesis, there was no significant difference between the pre-values on day 1 and day 4.

The validity and interpretation of our results depends heavily on the selection of effective neutralizing solutions. While this applies to all antiseptics, it is particularly relevant to CHG, because false-positive efficacy assessment in the absence of adequate neutralizers has been reported [ 44 ].

Soy bean or egg yolk lecithin is considered to be an effective neutralizer for CHG, and we used Lipofundin, which contains 1. Our study has two important limitations. However, we had to use readily available commercial formulations, due to the fact that PVP-I formulations are too difficult to prepare in-house. This means that our study unintentionally captured measurement values that were commonly located at the bottom end of the measurable range of the experimental setup.

This may be owed to the experimental conditions, including the size of the sampled skin sites and sample fractions plated on agar media, in combination with the relatively small number of 16 participants. As a result, it appears likely that any differences between the two antiseptics, contact times and immediate versus 3-h effects were underestimated. A scenario in which a larger number of the measured values would be located well within the measurable range would have a greater chance of showing statistically significant differences if they exist.

Future studies may be able to address this with larger numbers of volunteers, larger sampled skin sites, larger sample volumes or lower starting dilutions e. Commonly recommended contact times for surgical skin preparation, including the 2.

Starting from the hypothesis that a prolonged application time achieves better penetration and reaches deeper skin compartments and hair follicles, we decided to examine a contact time of 30 min in addition to 2. However, no relevant significant differences were observed between these contact times.

In addition, the question arises whether a contact time of 30 min is practicable in a busy operating room setting. This means that contact times shorter than 30 min should be investigated in future studies. For example, some antiseptic preparations, when applied for 2.

The 3-h values in our study aimed at assessing the sustained activity of the antiseptic and the intraoperative skin re-colonization under surgical drapes, as would be expected during typical operations. Federal Government. Read our disclaimer for details. Last Update Posted : August 27, Study Description.

Detailed Description:. After antisepsis four different cultures will be analyzed: The femoral nerve catheter will be removed after 48 hours and a culture of the distal tip of the femoral nerve catheter will be performed between the 2 arms. FDA Resources. Arms and Interventions. Chlorhexidine swabs will be used to antiseptically clean the skin, then cultures of the skin and femoral nerve block catheters will be analyzed via standard microbiological techniques.

Povidone-iodine swabs will be used to antiseptically clean the skin; then cultures of the skin and femoral nerve catheters will be performed by standard microbiologic techniques.

Outcome Measures. Primary Outcome Measures : Presence or absence of bacterial colonization of the distal femoral catheter tip 48 hours after antiseptic application [ Time Frame: July ]. Eligibility Criteria. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials. Franklin Hospital. Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections 4. Adverse events were similar in the two study groups. Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery.

Cardinal Health which provides both products used. Noorani A et al. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg ;97 11 Systematic review and Meta-analysis. Chlorhexidine vs povidone-iodine topical antiseptic preoperative skin prep. Differences in surgical site infections.

Chlorhexidine reduced postoperative surgical-site infection compared with povidone-iodine pooled OR 0. Chlorhexidine should be used preferentially for preoperative antisepsis in clean-contaminated surgery. Chaiyakunapruk N et al.