Surgery Infections Could be Reduced by Bathing Patients with Antiseptic

Researchers have found that hospitals may do better at preventing surgical site infections by bathing patients’ skin with CHG-alcohol instead of the reddish-brown iodine solution that is typically used.

In new studies published last week in the New England Journal of Medicine, U.S. researchers looked at the effectiveness of chlorhexidine gluconate (CHG) and alcohol in preventing hospital infections, compared to the familiar providone iodine (P-I). Researchers in the Netherlands also looked at patient screening and decolonization as means to combat the rising number of infections acquired by hospital patients.

The studies come as the number of hospital-acquired infections are on the rise, particularly those caused by Methicillin-resistant Staphyloccus aureus (MRSA). A study released in November in the U.S. Centers for Disease Control and Prevention’s Emerging Infectious Diseases medical journal, found that there has been a 90% increase in MRSA infections since 1999, and that MRSA may be responsible for 20,000 deaths annually in the U.S.

The U.S. study found that CHG-alcohol was better at preventing surgical site infections than P-I, reducing such infections by 40 percent. Doctors and medical experts looked at 849 subjects; 409 of whom were treated with CHG-alcohol before surgery, and 440 who were prepped with P-I. The CHG-alcohol was about twice as effective in preventing superficial incisional infections and deep incisional infections, but fared no better than P-I at preventing organ-space infections. The researchers, from universities and medical centers across the U.S., determined that preoperative cleansing with CHG-alcohol was superior to the more commonly used P-I.

The researchers in The Netherlands took a different approach. Instead of broad spectrum cleansing, they chose to attempt to control hospital infections by indentifying patients who carried dangerous infectious bacteria in their noses upon admission. In a study involving 917 patients at five hospitals, patients were screened to identify nasal carriers of staphylococcus aureus bacteria through screening. The patients identified as having the bacteria were treated with nasal ointments and antiseptic baths, which resulted in a 60 percent drop in surgical-site infections over placebo treatments. CHG-alcohol is already the standard in the Netherlands.

However, in an editorial in Journal Watch Infectious Diseases, Dr. Daniel J. Diekema, a clinical professor and associate director of the Clinical Microbiology Laboratory at the University of Iowa Hospitals and Clinics, said that the Netherlands research results was more likely the result of the antiseptic treatments, and that it is unclear just how much the attempt to screen the patients contributed to the reduction in surgical site infections.

“Until we know whether screening and targeted decolonization is superior to preoperative bathing of all patients with CHG soap, this approach should be reserved for high-risk procedures,” said Dr. Diekema, who is also Hospital Epidemiologist at the Iowa City Veterans Affairs Medical Center.