Journal Article

ALLERGIC TO CHLORHEXIDINE? A TRIAL OF PURE HYPOCHLOROUS ACID FOR SKIN DECONTAMINATION IN ONCOLOGY PATIENTS

Weathers, Katie, Savage, Elizabeth, Treacy, Patrick, Thelus, Kathleen, Petigny, Sandra

2025

Overview

Significance & Background: Central line-associated bloodstream infections (CLABSI) can significantly increase morbidity and mortality in immunocompromised patients. Chlorhexidine (CHG) is an antiseptic commonly used for skin decontamination; however, it is contraindicated for patients with compromised skin integrity and for those with an allergy to it. Although a small population of patients, the care team decided to trial a different product with the goal of equitable alternative disinfection in the prevention of CLABSI. A collaborative decision was made to trial pure hypochlorous acid (pHa) with the patients who are allergic to CHG or have compromised skin integrity. Purpose: To evaluate the efficacy of pHa for skin decontamination in reducing the incidence of CLABSI in patients with a CHG contraindication compared to standard skin decontamination protocols. Interventions: Patients identified as requiring an alternative to CHG disinfection included those with cutaneous T-cell lymphoma (CTCL) in addition to those with compromised skin integrity. As the addition of pHa would be a practice change, approval to trial the product needed to be obtained. An interdisciplinary team, consisting of Infection Prevention Medical Director, Oncology Medical Director, Wound & Ostomy, Clinical Nurse Specialist, Nursing quality, and Dermatology reviewed published data on pHa to determine the effectiveness as an alternative. CLABSI rates, skin irritation, and patient tolerance were monitored for eight months to ensure pHa is an acceptable substitution for CHG. Results: During the eight-month monitoring period there were no reports of CLABSIs, no skin irritation was reported by patients and the use of pHa was well tolerated. Discussion: Pure hypochlorous acid is a promising alternative for skin decontamination in an immunocompromised patient population. Next steps include reviewing the CLABSI policy to include the use of pHa for patients allergic/ sensitive to CHG or those with compromised skin integrity. The updated policy will then be shared with all campuses to ensure awareness of this enterprise-wide initiative and change. Monitoring this patient population for CLABSI, skin irritation or intolerance will be continued beyond implementation. The use of pHa in specific populations may further enhance infection control when used as directed. This product may be considered for use on a variety of patient populations, beyond what was discussed, to prevent infections, discomfort and intolerance of CHG.

• Publisher: Oncology Nursing Society
• Subject: Oncology / Patients / Skin integrity