The January 7, 2010 issue of the New England Journal of Medicine had two extremely important articles on infection prevention. The first was a randomized controlled trial of chlorhexidine-alcohol vs. povidone-iodine for surgical site antisepsis (Darouich et al 2010). This study showed that the chlorhexidine-alcohol group had significantly lower incidences of superficial incisional infections and deep incisional infections. But there was no difference in the rate of organ-space infections.
The lack of a good head-to-head study of these two antiseptics has been problematic in the past. In our efforts to reduce the risk of surgical fires, the debate about which antiseptic to use has been an unsolved one. Clearly the risk of fire is significantly higher with alcohol-based products. And since it had previously appeared that there was no substantial difference between the two products in antisepsis efficacy, there had been a trend toward using more povidone-iodine. However, the new study clearly shows superiority for the chlorhexidine-alcohol solution. So the real caveat now will be to ensure adequate drying time when using chlorhexidine-alcohol to reduce the risk for surgical fires.
The second paper (Bode et al 2010) looked at a strategy of rapid identification of nasal carriers of Staph aureus (using a PCR assay) followed by nasal decontamination with mupirocin nasal ointment and chlorhexidine soap in an effort to reduce surgical site infections. This was a randomized controlled multicenter trial. The nasal decontamination group had significantly fewer surgical site Staph aureus infections and the effect was most pronounced for deep surgical site infections.
Darouich RO, Wall MJ, Itani MF et al. Chlorhexidine–Alcohol versus Povidone–Iodine for Surgical-Site Antisepsis. NEJM 2010; 362:18-26
Bode LGM, Kluytmans JAJW, Wertheim HFL et al. Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus. NEJM 2010; 362:9-17