Effect on Skin Barrier and Usability of a Gentle 4% Chlorhexidine Hand Wash: A Prospective Randomized Controlled Trial

Background: 4% Chlorhexidine has been the recommended antiseptic wash ingredient to be used in healthcare institutions to prevent healthcare-associated infections.However, at this concentration, it can be damaging to the skin barrier and can often cause or worsen hand dermatitis.We formulated a gentle 4% chlorhexidine hand wash using a mild amphoteric surfactant and the addition of humectants, such that the antiseptic wash will potentially be less damaging to the skin barrier and is user-friendly for healthcare workers.Objective: We aimed to compare the effect of the formulated gentle 4% chlorhexidine hand wash on the skin barrier with a standard antiseptic hand wash, and to evaluate its usability amongst healthcare workers.Methods: In phase one, a double-blinded randomized controlled trial was conducted at the National Skin Centre, Singapore.Eighty participants were randomized into two groups: gentle chlorhexidine hand wash versus a comparative 4% chlorhexidine wash that is currently used in many of Singapore's hospitals (Microshield ® surgical hand wash, Schülke, Germany).The effect of the hand washes on skin barrier function was determined by measuring Trans-Epidermal Water Loss (TEWL) before and after handwashing.In phase two, all participants were provided with a 15ml fixed volume of the gentle chlorhexidine hand wash to use over 2 consecutive hours, and subsequently filled in a questionnaire that evaluates its usability.Results: The mean increase in TEWL after washing was lower in the gentle chlorhexidine hand wash group compared to Microshield ® surgical hand wash but the difference was not statistically significant (25.8 g/m 2 /h vs. 31.4g/m 2 /h; p=0.46).Subjective ratings of the gentle chlorhexidine hand wash were that it felt less drying, caused less skin sensitivity, had a nice texture and provided a feeling of cleanliness after washing.60% of participants felt that it was overall better than their usual chlorhexidine hand wash.Conclusion: The formulated gentle 4% chlorhexidine hand wash showed a trend towards lower increment in TEWL after hand washing compared to the standard Microshield ® wash.Subjective ratings indicated that the gentle chlorhexidine hand wash was well tolerated and usable.