OPTIONS IN MEDICAL MANAGEMENT
Before an operation, patients are advised to take a bath in an attempt to reduce the risk of surgical site infection.
Current practices being done by surgeons and hospitals: Chlorhexidine gluconate (exemplified by Esonex Shower / Bath Kit, Hibiclens and Hyclens) and bar soap containing triclorcarban (exemplified by Safeguard, Dial and Shield).
Cochrane studies have persistently shown “no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection.”
WHO in 2016 stated: “In conclusion, either a plain or antiseptic soap can be used for patient preoperative bathing, but the evidence was insufficient to formulate any recommendation on the use of chlorhexidine gluconate-impregnated cloths for the purpose of reducing SSIs.”
Immediate Side effects:
Skin irritations or allergies have been reported as immediate side effects for all types of skin cleansers. However, they are uncommon. There are no data comparing the relative frequency of skin irritations or allergies among the skin cleansers. Note, however, the USA FDA have issued a warning in 2017 on “rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate.” See excerpts below. It has identified 52 cases of anaphylaxis, a severe form of allergic reaction, with the use of chlorhexidine gluconate products applied to the skin.
Personally, I like to deduce from the above, that chlorhexidine gluconate has more serious allergic reactions than ordinary bar soaps.
Antibacterial vs Plain Bath Soaps:
USA FDA in 2016 had these statements in this regard:
“Consumers may think antibacterial washes are more effective at preventing the spread of germs, but we have no scientific evidence that they are any better than plain soap and water,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research (CDER). “In fact, some data suggests that antibacterial ingredients may do more harm than good over the long-term.”
“Washing with plain soap and running water remains one of the most important steps consumers can take to avoid getting sick and to prevent spreading germs to others. ”
In September 2017, the USA FDA has banned 19 ingredients in antibacterial soaps.
Ordinary bar soaps cost less than P20.00 for the 60 gram bar, depending on the brand. (Note: I still have to look for samples of non-antibacterial bar soap and their costs.)
Hyclens is about P125 per 60 ml. One needs more that 60 ml for a full bath.
Esonex is being sold at P550+ in one private hospital.
Personally, I recommend the use of ordinary bar soaps in preoperative bath.
I have been recommending / using it for my surgical patients for the past 35 years without any undue risk for postoperative wound infection.
Using ordinary bar soaps for preoperative bath is cost-effective.
Note and request to patients who have been operated by me and just used ordinary bar soap for preoperative bath:
PLS. GIVE FEEDBACK ON MY STAND AND RECOMMENDATION (MY ADVOCACY). IF YOU AGREE WITH ME, TYPE:
“I AGREE WITH THE RECOMMENDATION OF DR. ROJOSON TO JUST USE ORDINARY BAR SOAP FOR PREOPERATIVE BATH.”
ALLERGIC REACTIONS TO CHLORHEXIDINE GLUCONATE
USA FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate.
[2-2-2017] The U.S. Food and Drug Administration (FDA) is warning that rare but
serious allergic reactions have been reported with the widely used skin antiseptic
products containing chlorhexidine gluconate. Although rare, the number of reports of
serious allergic reactions to these products has increased over the last several years. As a
result, we are requesting the manufacturers of over-the-counter (OTC) antiseptic products containing chlorhexidine gluconate to add a warning about this risk to the Drug Facts labels. Prescription chlorhexidine gluconate mouthwashes and oral chips used for gum disease already contain a warning about the possibility of serious allergic reactions in their labels.
We identified 52 cases of anaphylaxis, a severe form of allergic reaction, with the use of chlorhexidine gluconate products applied to the skin. In the 46 years between January 1969 and early June 2015, FDA received reports of 43 cases worldwide.* More than half of the 43 cases were reported after 2010, and after our 1998 Public Health Notice. This number includes only reports submitted to FDA, so there are likely additional cases about which we are unaware. The serious allergic reaction cases reported outcomes that required emergency department visits or hospitalizations to receive drug and other medical treatments. These allergic reactions resulted in two deaths. Eight additional
cases of anaphylaxis were published in the medical literature between 1971 and 2015,1-3 and one case was identified in the National Electronic Injury Surveillance SystemCooperative Adverse Drug Event Surveillance (NEISS-CADES) database between 2004 and 2013.