ChloraPrep vs DuraPrep: differences, uses, safety tips

ChloraPrep and DuraPrep are both medical skin preparation solutions used to disinfect the skin before surgical or medical procedures. While ChloraPrep contains chlorhexidine gluconate and isopropyl alcohol, DuraPrep has iodine povacrylex and isopropyl alcohol as its active ingredients. The choice between the two depends on the specific needs of the procedure, as they differ in their antimicrobial components.

8 Key Differences between ChloraPrep and DuraPrep.

1. Active Ingredients:
   • ChloraPrep: Contains 2% chlorhexidine gluconate and 70% isopropyl alcohol.
   • DuraPrep: Typically contains iodine povacrylex (1.0% available iodine) and isopropyl alcohol.
2. Mechanism of Action:
   • ChloraPrep: Chlorhexidine gluconate has broad-spectrum antimicrobial activity against bacteria, fungi, and some viruses. Isopropyl alcohol enhances its effectiveness and provides quick drying.
   • DuraPrep: Iodine povacrylex releases iodine, which is also a broad-spectrum antimicrobial agent. Isopropyl alcohol aids in rapid drying.
3. Duration of Antimicrobial Activity:
   • ChloraPrep: Provides residual antimicrobial activity for several hours after application.
   • DuraPrep: Offers a persistent antimicrobial effect for an extended period.
4. Staining:
   • ChloraPrep: Chlorhexidine may cause staining on fabrics and some materials.
   • DuraPrep: Generally does not cause staining.
5. Use in Specific Procedures:
   • ChloraPrep: Widely used for a variety of medical procedures, including surgeries, catheter insertions, and skin preparations.
   • DuraPrep: Often used for surgical site preparation.
6. Applicator Design:
   • ChloraPrep: Typically available in a single-use applicator with a sponge or pad attached.
   • DuraPrep: Usually comes in a liquid form and may be applied with a brush applicator.
7. Compatibility with Skin:
   • ChloraPrep: Generally well-tolerated by most individuals, but some may experience skin irritation.
   • DuraPrep: Considered to be gentle on the skin, but individual reactions can vary.
8. Contraindications:
   • ChloraPrep: Individuals with a known hypersensitivity to chlorhexidine or isopropyl alcohol should avoid its use.
   • DuraPrep: Not recommended for individuals with a history of sensitivity to iodine.

What is ChloraprePrep?

ChloraPrep is a topical skin antiseptic solution used to disinfect the skin before surgical and medical procedures. This preoperative skin preparation delivers standardized, powerful, persistent antimicrobial protection for at least 7 days.

It typically contains the active ingredients chlorhexidine gluconate and isopropyl alcohol. The solution is commonly used to reduce the risk of infection at the site of surgical incisions, catheter insertions, and other invasive medical procedures. Chloraprep is known for its broad-spectrum antimicrobial activity and is widely used in healthcare settings to maintain a sterile environment during medical interventions.

How the active ingredients in ChloraPrep works.

1. Chlorhexidine gluconate:
   • Antimicrobial Action: Chlorhexidine gluconate is a broad-spectrum antimicrobial agent. It works by disrupting the cell membranes of bacteria, fungi, and some viruses, leading to their death or inhibition of growth.
   • Persistent Activity: One notable characteristic of chlorhexidine is its persistent antimicrobial activity. It continues to work for an extended period after application, providing prolonged protection against microbes.
2. Isopropyl Alcohol:
   • Rapid Disinfection: Isopropyl alcohol, also known as rubbing alcohol, is a common disinfectant. It works by denaturing and coagulating proteins in the cell membranes of microorganisms. This process leads to the destruction of the cell structure and the microorganism’s ability to function.
   • Quick Drying: Isopropyl alcohol evaporates quickly, which is advantageous in the context of skin preparation. It helps in achieving rapid disinfection and allows for a shorter drying time.

The combination of chlorhexidine gluconate and isopropyl alcohol in ChloraPrep provides a dual-action approach to skin antisepsis. Chlorhexidine offers long-lasting protection, while isopropyl alcohol ensures rapid disinfection. This combination is often used before medical procedures to reduce the risk of infections.

2 main Mechanism of Action of ChloraPrep

1. Chlorhexidine Gluconate:
   • Antimicrobial Properties: Chlorhexidine is a chemical antiseptic with broad-spectrum antimicrobial properties. It is effective against a wide range of bacteria, fungi, and some viruses.
   • Disruption of Cell Membranes: Chlorhexidine disrupts the cell membranes of microorganisms. It binds to the negatively charged components of the microbial cell surface, leading to leakage of intracellular components and ultimately causing cell death.
2. Isopropyl Alcohol:
   • Rapid Killing of Microorganisms: Isopropyl alcohol, also known as rubbing alcohol, is a potent disinfectant that acts by denaturing proteins and disrupting the cell membranes of microorganisms.
   • Dehydration of Cells: Isopropyl alcohol has a dehydrating effect on cells, leading to the precipitation of cellular proteins. This dehydration process contributes to the rapid killing of microorganisms.

Combined Action:

• The combination of chlorhexidine and isopropyl alcohol in ChloraPrep provides a synergistic effect, enhancing the overall antimicrobial efficacy.
• Chlorhexidine offers a persistent and residual antimicrobial effect, while isopropyl alcohol provides quick and immediate killing of microorganisms on the skin surface.

What is DuraPrep?

DuraPrep is a brand of antiseptic solution used in medical settings for skin preparation before surgical procedures. It contains a combination of active ingredients, typically iodine povacrylex and isopropyl alcohol, which help to disinfect the skin and reduce the risk of infection. DuraPrep is applied topically to the skin to create a sterile field around the incision site. It is commonly used to prepare the skin before surgeries, injections, or other medical procedures to maintain aseptic conditions and minimize the chances of bacterial contamination.

Research indicates that DuraPrep solution effectively maintains low resident bacteria counts for a minimum of 48 hours following exposure to blood and saline challenges. Additionally, it demonstrates effectiveness for at least 12 hours against transient bacteria.

Important Facts on How the active ingredients in DuraPrep works

1. Iodine Povacrylex:
   • Antiseptic Properties: Iodine is known for its strong antiseptic properties, meaning it has the ability to kill or inhibit the growth of microorganisms, including bacteria.
   • Broad-Spectrum Activity: Iodine povacrylex has broad-spectrum antimicrobial activity, making it effective against a wide range of bacteria.
2. Isopropyl Alcohol:
   • Disinfectant Action: Isopropyl alcohol is a common disinfectant that acts by denaturing proteins and disrupting the cell membranes of microorganisms.
   • Rapid Evaporation: It evaporates quickly, providing a rapid onset of antimicrobial action and leaving a dry, sterile surface.

Combined Action: The combination of iodine povacrylex and isopropyl alcohol in DuraPrep offers a synergistic effect. The solution provides both immediate and sustained antimicrobial activity. The isopropyl alcohol acts quickly to disinfect the area, while the iodine povacrylex continues to offer protection over an extended period.

Explaning the mechanism and action of DuraPrep ingredients

1. Iodine Povacrylex:
   • Antiseptic Properties: Iodine is well-known for its antiseptic properties. It has the ability to kill a broad spectrum of microorganisms, including bacteria, viruses, and fungi.
   • Cell Membrane Disruption: Iodine povacrylex can disrupt the cell membranes of microorganisms. This disruption leads to the inactivation and destruction of the microorganisms, preventing them from causing infections.
   • Persistent Antiseptic Action: Iodine povacrylex provides a persistent antiseptic effect, helping to maintain a sterile environment on the skin for an extended period.

2. Isopropyl Alcohol:

• Antiseptic and Antimicrobial Action: Isopropyl alcohol is a well-known antiseptic with strong antimicrobial properties. It is effective against various microorganisms, including bacteria.
• Rapid Evaporation and Drying: Isopropyl alcohol has a rapid evaporation rate, which facilitates quick drying of the skin. This is important in surgical settings to ensure that the skin is thoroughly dry before the procedure.
• Removes Surface Oils: Isopropyl alcohol helps to remove surface oils from the skin, further enhancing the effectiveness of the skin preparation.

🔑 Important Characteristics of ChloraPrep and DuraPrep

ChloraPrep:

1. Active Ingredients: ChloraPrep typically contains 2% chlorhexidine gluconate and 70% isopropyl alcohol.
2. Antimicrobial Properties: ChloraPrep is known for its broad-spectrum antimicrobial activity, providing effective disinfection against a range of microorganisms.
3. Applicator Design: It often comes in a single-use applicator with a unique design, allowing for controlled and precise application.
4. Drying Time: ChloraPrep is designed to dry quickly, ensuring that the skin is adequately prepared before medical procedures.
5. Color Change Indicator: Some versions of ChloraPrep have a color change indicator to visually show the coverage area.
6. ChloraPrep, relies on its liquid form and antimicrobial properties for skin disinfection.

DuraPrep:

1. Active Ingredients: DuraPrep usually contains 0.67% iodine povacrylex and 74% isopropyl alcohol.
2. Antiseptic Properties: DuraPrep is an antiseptic solution that combines the antimicrobial properties of iodine with the rapid evaporation of alcohol.
3. Applicator Design: Similar to ChloraPrep, DuraPrep is often available in a single-use applicator for easy and controlled application.
4. Drying Time: DuraPrep is designed to dry quickly, allowing for efficient skin preparation before medical procedures.
5. Duraprep has the characteristic of forming a water-insoluble film that immobilizes bacteria, which contributes to its effectiveness as a skin antiseptic in medical settings.

🔑6 Warnings when to Not Use Chloraprep

1. Refrain from applying ChloraPrep on open skin wounds, broken, or damaged skin.
2. Ensure ChloraPrep does not come into contact with neural tissues or the middle ear.
3. Exercise caution, as Chlorhexidine is incompatible with soap and other anionic agents.
4. Avoid bringing alcohol into contact with certain vaccines and skin test injections (patch tests), ChloraPrep contains alcohol.
5. Do not use if allergic to Chlorhexidine.
6. Do not use on infant less than 2 months old.

Key Important points to take into consideration when using ChloroPrep

1. Avoid getting solution into hairy areas. Hair may take 1hr to dry, wet hair is flammable.
2. Remove wet materials from prep area.
3. Do not allow solution to pool.
4. Do not drape or use ignition source like cautery, laser until solution is completely dry. A minimum of 3mins on hairless skin to dry up to 1 hr on hair.
5. Solution contains alcohol and gives of flammable vapors.
6. Do not use a 26 ml applicator for head or neck surgery or on area smaller than 8.4 inches X 8.4 inches ,use a smaller applicator.

4 Easy step when to apply ChloraPrep

1. Hold the applicator, do not touch sponge, squeeze applicator lever to activate and release antiseptic.

2. Allowing the solution to saturate the sponge, then you can gently press the applicator against area intended to disinfect. When the solution become visible on skin, gentle apply back and forth strokes to prep the incision site for 30 seconds.

3. Allow area to dry for 3mins for dry and moist site.

4. Do not blot or wipe solutions away. Solution must be dry for optimal drape/dressing adhesion.

Do you think ChloraPrep and DuraPrep are better than Povidone-iodine (Betadine) ?

ChloraPrep

Exposure to bodily fluids could deactivate Povidone-iodine (Betadine)  containing topical antiseptic agents but with ChloraPrep the quick onset of action and sustained effectiveness of chlorhexidine persist even when the skin is in contact with bodily fluids.

Studies, have shown application across various indications suggest that the topical application of chlorhexidine gluconate-70% isopropyl alcohol solution on the skin is more efficacious in preventing skin or wound infections before invasive or surgical procedures compared to povidone-iodine (Betadine).

ChloraPrep, which contains 2% chlorhexidine gluconate and 70% isopropyl alcohol (CHG + IPA) in a 3.0-mL applicator, was tested in a trial against 70% IPA or a 2% CHG aqueous solution. All three antiseptics effectively reduced microbial counts on the skin at 10 minutes, 6 hours, and 24 hours after application. CHG + IPA showed better and longer-lasting antimicrobial activity on the skin compared to IPA or CHG alone at the 24-hour mark. Importantly, no skin irritations were reported for any of the antiseptics used in the study.

DuraPrep

Two separate research studies found that when bacteria come into contact with DuraPrep film, they are eliminated for at least 12 hours. Additionally, transparent dressings with DuraPrep film help maintain low bacteria counts for up to three days. In a lab study comparing DuraPrep film with Betadine, it was observed that DuraPrep released more iodine than Betadine over a three-hour period.

The double action of iodine povacrylex and Isopropyl alcohol give DuraPrep superiority over betadine when it come to skin prep for surgical procedures. The applicator is equipped with flow control, which helps decrease the accumulation of liquid.

According to a study in the American Journal of Infection Control, found that application of DuraPrep kill 99.99% of bacteria just 15 seconds after application. The research also indicates that the solution dries fast and continues to be effective for over 24 hours after use.

🔑Warnings and considerations when Using DuraPrep

For external application only. Highly flammable; keep away from fire or open flame. Take precautions to minimize the risk of fire:

• Do not use the 26 mL applicator for head and neck surgery.
• Avoid using the 26 mL applicator on an area smaller than 8 in. x 10 in.; opt for a smaller applicator instead.
• The solution contains alcohol and emits flammable vapors.
• Refrain from draping or using an ignition source (e.g., cautery, laser) until the solution is completely dry (at least 3 minutes on hairless skin; up to 1 hour in hair).
• Exercise caution to prevent the solution from coming into contact with hairy areas, as wet hair is flammable and may take up to 1 hour to dry.
• Prevent the solution from pooling.
• Promptly remove materials stained by the solution from the preparation area.

Avoid using this product:

• On patients known to have allergies to iodine or any other ingredients in this product.
• On open wounds, mucous membranes, or as a general skin cleanser.
• On infants less than 2 months old, as it may pose a risk of excessive skin irritation and transient hypothyroidism.

Can ChloraPrep and DuraPrep be used on Infants?

It is recommended that ChloraPrep and DuraPrep not be used on infants less than two months old, neonates (pre-mature babies),children with very sensitive skin and children with allergies to betadine and chlorohexidine. The potential for skin injuries, including redness, burns, and blisters, is a concern in the development of antiseptic solutions like chlorhexidine gluconate (CHG). Presently, guidelines do not endorse the use of CHG for neonates due to insufficient safety data, especially in premature infants.

However, despite this lack of data, CHG is frequently employed globally for unofficial purposes in neonatal intensive care units. A specific clinical case involves an infant born at 26 weeks of gestation who experienced a chemical burn related to CHG during skin antisepsis.

Cost of ChloraPrep and DuraPrep

ChloraPre and DuraPrep comes in several different sizes, from 26 mls applicators to 3mls applicators. Prices for ChloraPrep ranges from $200 and up, the ones with tint tends to be more pricy.DuraPrep comes in 26mls and 6mls applicator.

DuraPrep tends to be more cheaper and you can find it for under $100.Prices varies depending on size and suppliers.

History and Origin of ChloraPrep and DuraPrep

ChloraPrep History and Origin

Chlorhexidine, discovered in 1946 and introduced in 1954, has been a crucial antibacterial agent for over 60 years. Initially created in the 1950s by Imperial Chemical Industries in the UK while seeking an anti-malarial solution, it became widely used in medicine.

In the 1970s, Chlorhexidine soap revolutionized surgery preparation, significantly reducing infection and mortality rates. It expanded to urology in 1981 with catheters infused with Chlorhexidine and Silver sulfadiazine.

The 1990s saw the introduction of sponge dressings impregnated with Chlorhexidine, minimizing bacterial infections post-surgery. In 2010, IV and needle connectors began incorporating Chlorhexidine, and by 2012, PICC lines and Central Lines followed suit, further lowering infection risks for patients requiring IV medications.

On December 1, 2002, the United States Food and Drug Administration (FDA) approved the marketing of ChloraPrep One-Step Sepp applicator, made by Medi-Flex, Inc., a company in Overland Park, Kansas. Chloraprep, became available on January 16, 2003.

DuraPrep History and Origin

DuraPrep surgical solution has been available and used in more than 20 million preoperative patient skin preparation procedures since 1988. DuraPrep came on the market October 5th 2006 ,was approved by The Food and Drugs Administration.

Resources

Everyday in my field of profession we use ChloraPrep and DuraPrep 85% of the time for our antiseptic need for our patients. Most of my Information is derive from my experiences with these two products and from my on the job research as well.

https://pubmed.ncbi.nlm.nih.gov/12131506/

https://www.ebmconsult.com/articles/skin-preparation-surgery-chlorhexidine-chloraprep-povidone-iodine#

https://www.infectioncontroltoday.com/view/fda-approves-chloraprep-one-step-sepp-applicator

https://www.infectioncontroltoday.com/view/fda-approves-new-drug-application-3m-duraprep-surgical-solution