To bathe or not to bathe with chlorhexidine gluconate: is it time to take a stand for preadmission bathing and cleansing?

any health care facilities have incorporated an antiseptic skin cleansing protocol, often referred to as preoperative bathing and cleansing, to reduce the endogenous microbial burden on the skin of patients undergoing elective surgery, with the aim of reducing the risk of surgical site infections (SSIs). According to a recent study by Injean et al, 91% of all facilities that perform coronary artery bypass surgery in California have a standardized preoperative bathing and cleansing protocol for patients. Historically, this practice has been endorsed by national and international organizations, such as the Hospital Infection Control Practice Advisory Committee and the Centers for Disease Control and Prevention, the Association for Professionals in Infection Control and Epidemiology (APIC), AORN, the Institute for Healthcare Improvement (IHI), and the National Institute for Health and Care Excellence (NICE), which recommend bathing and/or cleansing with an antiseptic agent before surgery as a component of a broader strategy to reduce SSIs. The 2008 Society for Healthcare Epidemiology of America (SHEA)/ Infectious Diseases Society of America (IDSA)/Surgical Infection Society (SIS) strategies to prevent SSIs in acute care hospitals declined to recommend a specific application policy regarding selection of an antiseptic agent for preoperative bathing but acknowledged that the (maximal) antiseptic benefits of chlorhexidine gluconate (CHG) are dependent on achieving adequate skin surface concentrations.