Skin anti-sepsis: Chloraprep guideline

ChloraPrep is a combination of 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol (IPA). A series of ChloraPrep products were launched, which have been given the highest recommendation by the Health Promotion Agency’s Review Panel (Health Promotion Agency)¹. 

CHG maintains a persistent antimicrobial function by disrupting the cell membrane and precipitating their contents. IPA quickly destroys microorganisms by denaturing cell proteins, giving significant defense against broad-spectrum micro-organisms and rapid bactericidal action1,2.

CHG is an effective skin antisepsis agent:

• Potent broad spectrum germicidal action, thus rendering it effective against nearly all nosocomial bacteria and yeasts.
• Low skin irritancy and sensitization potential.
• Strong affinity for skin and shows prolonged duration of antimicrobial effect.
• The antibacterial effect persists for hours after application and not neutralised by contact with proteinaceous substances, such as blood.
• Bacterial resistance is rare.
• Not associated with patient adverse events (with iodine, there have been reports of toxic effect on the thyroid gland in neonates³).

Combining CHG with another antiseptic with different mechanisms is additive and beneficial².

Comparison of Antimicrobial Agents used in Skin Antisepsis2

National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in NHS hospitals were first published in 2001.  The Department of Health (DoH) funded and endorsed an update in 2007 (epic2, Pratt et al)4.  The DoH has since commissioned a review of further evidence to update these guidelines, concluding that the epic2 guidelines remain ‘robust, relevant and appropriate’(5), however there have been some changes and additions.

The following guidelines relate to the use of Chloraprep for intravascular devices:

Cutaneous antisepsis

IVAD14 - Decontaminate the skin at the insertion site with a single-use application of 2% chlorhexidine gluconate in 70% isopropyl alcohol (or povidone iodine in alcohol for patients with sensitivity to chlorhexidine) and allow to dry prior to the insertion of a central venous access device. (Class A)

IVAD 15  - Decontaminate the skin at the insertion site with a single-use application of 2% chlorhexidine gluconate in 70% isopropyl alcohol (or povidone iodine in alcohol for patients with sensitivity to chlorhexidine) and allow to dry before inserting a peripheral vascular access device. (New recommendation – Class D/GPP)

Intravenous catheter and catheter site care

IVAD23 – Use a single use application of 2% chlorhexidine gluconate in 70% isopropyl alcohol (or povidone iodine in alcohol for patients with sensitivity to chlorhexidine) to clean the central catheter insertion site during dressing changes, and allow to air dry. (Class A)

IVAD24 – Use a single use application of 2% chlorhexidine gluconate in 70% isopropyl alchol (or povidone iodine in alcohol for patients with sensitivity to chlorhexidine) to clean the peripheral venous catheter insertion site during dressing changes, and allow to air dry. (New recommendation – Class D/GPP)

There are a number of ChloraPrep products available: 1ml applicator, 3ml applicator, 10.5ml applicator, 26ml applicator, swabsticks, Frepp 1.5ml applicator and Sepp 0.67ml applicator6.  The common ones used in PICU are listed below:

ChloraPrep swab – contains swab with 2% CHG in 70% IPA

Most suitable for antisepsis of catheter ports.

ChloraPrep applicator – contains 3ml of 2% CHG in 70% IPA

Most suitable for skin antisepsis preparation before insertion of central venous catheter devices. 

ChloraPrep Sepp applicators 0.67ml of 2% CHG in 70% IPA

Most suitable for use for asepsis for insertion of peripheral venous cannulas or obtaining peripheral blood cultures.