Chlorhexidine gluconate vs ordinary wash product for preoperative body bath

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).

BENEFIT

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.”

https://rojosonmedicalclinic.wordpress.com/2015/03/10/bath-before-an-operation-advised-to-reduce-risk-for-infection-on-operative-site-and-use-of-regular-bar-soaps/

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.”

https://rojosonmedicalclinic.wordpress.com/2016/11/05/preoperative-bathing-to-prevent-surgical-site-infection-2016-who-recommendations/

RISK

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:

http://asepticenclosures.com/index.php/fda-issues-final-rule-on-safety-and-effectiveness-of-antibacterial-soaps/

“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.

https://www.healio.com/infectious-disease/antimicrobials/news/online/%7Bac16b11f-98da-45a4-8489-9b2bf205197e%7D/fda-rule-banning-19-ingredients-from-antibacterial-soaps-takes-effect

COST

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.

ROJoson’s TPOR:

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.”

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ALLERGIC REACTIONS TO CHLORHEXIDINE GLUCONATE

USA FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate.

https://www.fda.gov/downloads/Drugs/DrugSafety/UCM539059.pdf

Safety Announcement
[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.

 


ROJ@18feb4

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17 Responses to Chlorhexidine gluconate vs ordinary wash product for preoperative body bath

  1. Ate Alma says:

    Yes! true po ito in my personal experience. ” i agree with the recommendation of dr. Joson using ordinary bathsoap for pre operative and post operative bath ( i only used dove bar soap and safeguard bar soap)

  2. Virna Mapile says:

    After my operation (MRM) last May 2014, Doc Joson advised to clean my wound with a regular soap (in my case, I used Safeguard) and a running water and even said that there will be no need to apply Betadine after. I obeyed without hesitant and was amazed that it worked! Thank you Doc for the practical advise and for being the best Doctor ever! Pa-hug po! 🙂

  3. Virginia Snatos Carrasco says:

    I agree with the recommendation of Dr. Rojoson just to use ordinary bar soap for pre operative bath.Thank you Dr. !!!😊😊😊😊😊

  4. Reynaldo B. Jonson says:

    I agree with your recommendation sir to just use ordinary bar soap for preoperative bath.
    My mom didn’t experience any surgical site infection post MRM.
    It is indeed cost effective.

  5. Laura C. Pajares says:

    I AGREE WITH THE RECOMMENDATIONS DR. DR. ROJOSON TO JUST USE ORDINARY SOAP FOR PREOPERATIVE BATH.
    “Yes, this is true, i can attest to that … 2days after my surgery, ”mastectomy “ , i was advised to take a bath and i use plain soap only. My surgery site healed fast ..

  6. Anicia "Annie" Atienza Pangilinan says:

    Hi Doc Joson! After my breast operation almost 4 years ago,I only use safeguard &white dove soap.. “I agree with the Recommendation of Dr. ROJoson to just use ordinary soap for Preoperative Bath”

  7. Maria Eina says:

    Yes, I AGREE WITH THE RECOMMENDATION OF DR. ROJOSON TO JUST USE ORDINARY BAR SOAP FOR PREOPERATIVE BATH. Actually before my operation in the morning (Nov. 17, 2014) I was advised to take a bath with the “Bath Kit” the nurses had given me I did not use it because I was not familiar with the soap and instead I used my own ordinary bar soap (safeguard white) that I brought because I was already used to it.

    After 3 weeks of my MRM my surgery wound totally opened and when Dr. ROJOSON saw it he just advised me to wash it with warm water and an ordinary bath soap 3x a day and I just obeyed and the wound just healed without any betadine applied on it.

    Thank you so much DR. ROJOSON, I have saved a lot, no extra expenses just the ordinary soap I was using everyday and it was healed.

  8. Joan U says:

    I AGREE WITH THE RECOMMENDATION OF DR. JOSON TO JUST USE ORDINARY BAR SOAP FOR PREOPERATIVE BATH. After my operation i was advised to use an ordinary bath soap to clean the wound and I didn’t experience any skin irritations or any allergic reactions. Thanks Doc Joson 🙂

  9. Edith C. Limbo says:

    I agree with Dr. Joson’s recommendation. I used my regular bath soap after my operation.
    No skin irritation. No allergic reactions. No infection. I’m happy that I don’t need to spend a lot for a bath soap. Everything is good. Thank you Dr. Joson for sharing and for taking care of my health.

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