Surgical skin preps can reduce infection.

Scottsdale – The Associated Press has highlighted newly published results on techniques to curb infection after surgery. The study published in the New England Journal of Medicine this past week, compares the use of povidone-iodine (the established method) against a new preoperative skin cleansing solution, chlorhexidine-alcohol. The theory behind this clinical trial is derived from information that points to the patient’s skin as a major source of bacteria. These bacteria are implicated as a cause of surgical-site infection. This research compares the two bacterial killing skin solutions to see if one is better than the other.

The study was carried out at hospitals associated with the Baylor College of Medicine, Boston University Medical School, and the Medical College of Wisconsin. For the study, the patients were randomized at six hospitals to preoperative skin preparation with either chlorhexidine–alcohol scrub or povidone–iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. A total of 849 subjects were enrolled.  There were 409 in the chlorhexidine–alcohol group and 440 in the povidone–iodine group.

The results demonstrated an overall rate of surgical-site infection significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5% vs. 16.1%). This difference is significant between the two groups. In other words, the chlorhexidine-alcohol group performed better and had less infections. Chlorhexidine–alcohol was also significantly more protective than povidone–iodine against both superficial incisional infections (4.2% vs. 8.6%) and deep incisional infections (1% vs. 3%). Against organ-space infections (4.4% vs. 4.5%) both skin preps performed well.

The researchers concluded that preoperative cleansing of the patient’s skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery. Tummy tuck, breast augmentation, and other plastic surgery procedures would be categorized under superficial and deep incisional surgery.

I switched to the new chlorhexidine–alcohol last year,  in my practice. It is very effective and continues to work 48 to 72 hours after surgery. This is just one of those advancements, that as a patient, you almost never hear about.