Treating the patient's skin with chlorhexidine before surgery can be an effective safeguard against surgical site infection, according to 2 new studies published in the New England Journal of Medicine this week.
Both studies highlight promising strategies for preventing SSIs caused by bacteria that patients carry on their skin and nasal sites:
Screening and treating for Staphylococcus aureus. "About one-third of people at any one time carry this bacterium in their nose or on their skin," says Henri Verbrugh, MD, professor of medical microbiology at Erasmus University Medical Center in the Netherlands. Dr. Verbrugh and colleagues screened 6,771 patients from October 2005 to June 2007 for S. aureus using a real-time, polymerase-chain-reaction assay. Patients whose nasal swabs were positive for the bacteria were treated either with mupirocin nasal ointment and chlorhexidine showers or placebo for 5 days. The rate of S. aureus infection after surgery was 3.4% in the mupirocin—chlorhexidine treatment group, compared to 7.7% in the placebo group.
The authors conclude that the "rapid screening and decolonizing of nasal carriers of S. aureus on admission" can reduce the rate of SSIs caused by this bacteria in hospitals.
Chlorhexidine-alcohol trumps povidone-iodine. That's the conclusion of a study, financed by CareFusion, that compared the effects of the 2 common surgical skin preps in 849 patients undergoing clean-contaminated surgery at 6 hospitals. The SSI rate in the chlorhexidine-alcohol group was 9.5%, compared to 16.1% in the povidone-iodine group. Researchers found chlorhexidine-alcohol to be significantly more effective in both superficial and deep incisional infections, but not organ-space infections.
Another big difference between the 2 preps, however, is cost. Study author Rabih O. Darouiche, M.D., professor of medicine at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, notes that chlorhexidine-alcohol is 3 to 4 times more expensive per patient than povidone-iodine.
A copy of the full study is available at [email protected].
Irene Tsikitas
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