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Robbin George
CHG efficacy in the presence of skin prep

We are preparing to trial the CHG Tegederm for inclusion in some of our CVC dressing change kits and was advised that the skin prep (Aplicare) in our kits contains "Anionic Polymers which in theory could reduce the amount of soluble CHG causing a potential loss in efficacy"--We have been using the kit and adding a Biopatch when needed for the past 2 years--   What is the research that can help us council the nurses about the usie of skin prep and either of the CHG dressings--How do we determine if a skin prep is Non-Ionic?

Thank you in Advance for your responses

Robbin George RN                                                                                                                                                                                                                                    Vascular Access Resouce Dept Alexandria Hospital Virginia

 

Peter Marino
Interesting! Who suggested it?

I looked at the MSDS for skin prep http://www.aplicare.com/catalog/msds/skinprotectantsaturatedswabsticks.pdf and could not find any anionic polymers listed. But that doen't mean there may not be any in the product. I would contact Applicare directly (800-760-3236) and ask. I would also contact chloraprep.

I also found a Guide to surgical scrubs http://www.outpatientsurgery.net/resources/forms/2005/pdf/OutpatientSurgeryMagazine_0502_SkinPrepsFull.pdf It only mentions lotions containing Lecithin to weaken or deactivate Chloraprep.

Please report back what you find. We are currently using skin prep after appling chloraprep.

 

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

Peter Marino
Follow-up post / No anionic polymers in SkinPrep

I called Aplicare and spoke to "Paul" who assured me that their skin prep product does not contain any anionic polymers.

Here is an abstract about this topic of anionic polymers and chlorhexidine.... Inactivation of chlorhexidine gluconate on skin by incompatible alcohol hand sanitizing gels; http://www.ajicjournal.org/article/S0196-6553(09)00075-3/abstract

 

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

Ann Marie
CHG efficacy with skinprep

When our rep in serviced us she told us to aviod putting skin prep in the area where the SHG gel pad will be as it is less effective as it has harder time penetratng  the skin prep to get to the skin

 

Ann Marie

Ann Marie Parry RN CRNI

VITALine infusion pharmacy

Peter Marino
Just a clarification

Was it the skin prep rep or the dressing rep? Is "SHG" a silver product?

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

AMParry
CHG efficacy with skinprep

Oops meant CHG not SHG - my fingers are dancing thier own dance!

It was the CHG rep that made the comments.

 

Ann Marie

lynncrni
Has anyone actually seen this

Has anyone actually seen this in any written format from any CHG manufacturer? Anything that a manufacturer rep says is considered labeling and should be backup by written information. If that is not seen, I have to wonder, why the local rep is making such a statement. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Robbin George
Lynn--I phoned the Aplicare

Lynn--I phoned the Aplicare skin prep company but they never returned my call--I have received a letter from 3M explaining the reps statement regarding the issue of CHG efficacy and have tried to find a way to insert a word document on this page without success so I will email it to you so you can read it and hopfully be more successful at posting it on the iv-therapy.net site--Thanks--Robbin George RN Vascular Access Resource Dept. Alexandria Hospital Virginia

Robbin George RN VA-BC

Chris Cavanaugh
Skin prep not near site

I was always taught that skin prep should be applied where the boarder of the dressing is, not  near the site, where the Biopatch would go, or the CHG in the Tegaderm CHG

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Peter Marino
No word Doc. needed

 Robbin, you should be able to copy and paste the response right in a post. No need to put the whole word DOC. in.

Chris, that is how I was taught also.

Thanks Ann Marie.

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

Robbin George
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2.13.10

 

 

Dear Customer:

 

Thank you for your inquiry regarding 3Mä Cavilonä No Sting Barrier Film. Cavilon No Sting Barrier Film is an alcohol-free liquid barrier film that dries quickly to form a breathable, transparent coating on the skin. It is designed to protect intact or damaged skin from urine, feces, body fluids, adhesive trauma, and friction.  Cavilon No Sting Barrier Film may be used to protect the skin surrounding infusion devices from adhesive damage. Because of this, it is important to know that Cavilon No Sting Barrier Film does not interact with Chlorhexidine gluconate (CHG) remaining on the skin following the use of a skin prep such as ChloraPrep®.

 

Cavilon No Sting Barrier Film contains a silicone acrylate terpolymer which is nonionic.  It would be expected that the Cavilon No Sting Barrier Film and Chlorhexidine Gluconate would be compatible since the risk of interaction is primarily a concern with anionic materials.  In contrast, barrier film (“skin protectants”) which contain the anionic polymers PVM/MA copolymer (polyvinylmethyl ether maleic acid copolymer) could, in theory interact with CHG.  Examples of products that contain PVM/MA Copolymer include: Sureprep® Protective Wipe, Triad® Plus Skin Protectant Prep Pad and Aplicare® Skin Protectant Prep Pad. The primary concern is that literature references establish that when Chlorhexidine is converted, wholly or partly, to an insoluble salt by reaction with an anionic compound, a loss of antibacterial action is to be expected.

[i]

 

3M conducted a study to determine the compatibility of Cavilon No Barrier Sting Film with Chlorhexidine gluconate. A relatively simple test demonstrates the inactivation of CHG when it precipitates with anionic salts. In this method, dilute solutions of CHG can be colorimetrically quantified by the addition of sodium hypochlorite, which forms a brownish color. The presence of soluble CHG can be observed by the color of the solution.

[ii]

In other words, the darker the solution, the greater the concentration of CHG. If a brownish color does not appear following addition of the sodium hypochlorite the CHG has been largely converted to an insoluble salt and is no longer available in solution to be antimicrobially active. Test results for Cavilon No Barrier Sting Film indicated equivalent color formation in both the test and control samples. The combination of Cavilon No Barrier Sting Film and a dilute solution of CHG turned an orange-brown color indicating the CHG was soluble and available. These results confirm the chemical compatibility of No Sting Barrier Film with Chlorhexidine Gluconate.

 

 

 

Please do not hesitate to contact me should you have additional questions.

 

 

Sincerely,

 

 

Debra Thayer MS, RN, CWOCN

Technical Services Specialist

Cavilon Skin Care

651-733-1447 (Office)

612-385-4234 (Mobile)

800-228-3957 (Toll Free)



i Senior N., Some observations on the formulation and properties of Chlorhexidine, J.

Soc. Cosmet. Chem. 24, 259-278 (1973)

ii Holbrook, A. The determination of small quantities of Chlorhexidine in pharmaceutical preparations. J. Pharm. Pharmacol. 10 370 (1958).

 

ChloraPrep® is a registered trademark of enturia

Sureprep® Protective Wipe is a registered trademark of Medline Industries Inc.

Triad® Plus Skin Protectant Prep Pad is a registered trademark of the Triad Group Inc.

Aplicare® Skin Protectant Prep Pad is a registered trademark of APLICARE, Inc.

 

Robbin George RN VA-BC

Peter Marino
Aplicare® Skin Protectant is anionic

Thanks Robbin for posting the letter. I called Paul back with the information you posted and he looked into it further and apologized. Aplicare® Skin Protectant is anionic.

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

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