Skin Preparations Decrease Risk of Surgical-Site Infections

Reduced risk seen with mupirocin nasal ointment and chlorhexidine soap, chlorhexidine-alcohol
By Rick Ansorge
HealthDay Reporter

WEDNESDAY, Jan. 6 (HealthDay News) -- Simple preoperative skin preparations may significantly reduce the risk of surgical-site infections, according to two studies in the Jan. 7 issue of the New England Journal of Medicine.

In one study, Lonneke G.M. Bode, M.D., of the Erasmus University Medical Center in Rotterdam, Netherlands, and colleagues randomly assigned 808 Staphylococcus aureus nasal-positive patients undergoing surgery to receive treatment with mupirocin nasal ointment and chlorhexidine soap or placebo. They found that treatment was associated with a significantly decreased risk of surgical-site infections (relative risk, 0.42), especially deep surgical-site infections (relative risk, 0.21).

In a second study, Rabih O. Darouiche, M.D., of the Baylor College of Medicine in Houston, and colleagues randomly assigned 849 adults undergoing clean-contaminated surgery to receive preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. They found that chlorhexidine-alcohol was more protective than povidone-iodine against superficial incisional infections and deep incisional infections, but not against organ-space infections.

"In summary, the weight of evidence suggests that chlorhexidine-alcohol should replace povidone-iodine as the standard for preoperative surgical scrubs," states the author of an accompanying editorial. "The use of intranasal mupirocin and chlorhexidine baths for carriers of S. aureus who have been identified preoperatively by means of a real-time polymerase-chain-reaction assay could be reserved primarily for patients who are undergoing cardiac surgery, all patients receiving an implant, and all immunosuppressed surgical candidates."

Several authors of both studies reported financial relationships with pharmaceutical companies.

Abstract - Bode
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Abstract - Darouiche
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Editorial (subscription or payment may be required)

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