Cleansing a patient’s skin prior to surgery with chlorhexidine alcohol – instead of the more commonly used povidone iodine – has proven to be a more effective and powerful barrier to reducing or preventing infections after surgery.
Research comparing the two strategies was reported in the Jan. 7, 2010, issue of the New England Journal of Medicine. The study was co-authored by Alexandra Webb, MD, assistant professor of surgery, Emory School of Medicine, and chief of general surgery at the Atlanta Veterans Affairs Medical Center. The findings by Webb and her team are important, as hospitals and health care providers are continuously striving to reduce and eliminate surgical site infections in patients.
The study was a randomized clinical trial between April 2004 and May 2008 at six university-affiliated hospitals across the United States, including the Atlanta Veterans Affairs Medical Center, which is affiliated with Emory School of Medicine. A total of 897 patients were randomly assigned to a study group: 431 to the chlorhexidine–alcohol group and 466 to the povidone–iodine group. Of the 849 patients who qualified for the intention-to-treat analysis, 409 received chlorhexidine alcohol and 440 received povidone iodine.
Webb and the team found that using chlorhexidine as the preoperative skin cleanser reduced infections by 41 percent compared with povidone iodine.
“This is a very important study on skin preparation to prevent surgical site infection on many levels and should be evaluated for consideration of change of practice in surgical protocol,” says Christian Larsen, MD, chair of the Department of Surgery, Emory School of Medicine. “This is an example of research that directly impacts the quality of patient care. A reduction of the surgical site infections of this magnitude would greatly reduce morbidity and have a major economic impact for hospitals, patients and employers around the country.”
More than 27 million surgical procedures are performed each year in the United States. According to the Centers for Disease Control and Prevention, there are approximately 1.7 million health care-associated infections each year in U.S. hospitals. Of these infections, 22 percent – or about 400,000 – are surgical site infections, which result in longer hospital stays, readmission or sometimes death.