Clinical trial reports and systematic reviews assessing the clinical efficacy of chlorhexidine and alcohol combinations as skin disinfectants may be misleading, as reported disinfectant properties only consider the chlorhexidine component, according to a study in Journal of Antimicrobial Chemotherapy.
Researchers examined studies comparing the clinical efficacy of the chlorhexidine/alcohol combinations versus a povidone-alone antiseptic. They note these comparisons are inaccurate and inadequate as they were testing the result of a combined antiseptic product against the result of a singular antiseptic product.
In their review of articles' conclusions of efficacy of antiseptic products, they found between 29 and 43 percent of studies incorrectly attributed the efficacy of the chlorhexidine/alcohol combination only to the chlorhexidine, ignoring the alcohol element. Approximately 35 percent of articles correctly listed the tested antiseptics and correctly attributed disinfecting efficacy to the corresponding antiseptics.
"Effects cannot be attributed to one factor, when in fact several factors were tested in combination," the authors wrote, adding the misinterpretation of clinical evidence has led to clinicians mistakenly rejecting alternative antiseptics.
The inaccurate conclusions have led to "unsubstantiated" recommendations in clinical guidelines and protocols, researchers said.
Additionally, researchers said the misconception of antiseptic efficacy has consequences on patient safety and evidence-based medicine.
"The chlorhexidine misinterpretation has affected a significant proportion of the medical literature and contaminated the entire path of evidence assessment, from clinical trials, systematic reviews, narrative reviews, keynote presentations at conferences and simple clinical practice recommendations all the way through to evidence-based clinical practice guidelines," they wrote.
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