Even with the pre-operative measures that are currently in place, surgical research has indicated that there are between 300,000 to 500,000 cases in the U.S. where infection occurs at the surgical site. While surgeons use antiseptic techniques, there have been no studies conducted where antiseptics have been compared and contrasted in their ability to prevent surgical site infection.
In the January 7th 2010 issue of the New England Journal of Medicine, several physicians operating collaboratively in hospitals across the U.S. compared and contrasted the occurrence of surgical site infection following application of the most commonly used skin antisepsis preparation (in the U.S.), povidone-iodine with chlorhexidine-alcohol, a preparation most often used to cleanse the site where a catheter is to be inserted.
Overall, the results of this study demonstrate that chlorhexidine-alcohol application (a scrub) resulted in a significantly lower incidence of surgical site infection (9.5% of occurrence) than pre-operative scrubbing with povidone-iodine (16.1%). Upon closer inspection of the data, these researchers determined that chlorhexidine-alcohol was more effective than povidone-iodine at preventing surgical site infections that involved superficial incisions (surgery involving only skin and subcutaneous tissue) and surgeries involving deep incisions (surgery involving fascia and muscle). However, when the surgery involved organs or the deeper than the abdominal wall, there was no significant difference in the antisepsis action between these two applications.
The authors of this study note that while both antisepsis preparations are considered to have broad-spectrum antimicrobial actions, chlorhexidine-alcohol is more rapid in action and has more persistent antimicrobial activity than the more commonly used povidone-iodine. One concern noted by the authors is the potential for a small fire or chemical skin burn when using an alcohol-based solution in the operating room, however, there was no such occurrence in this study or others using this preparation. It will be interesting to see the impact this study has on future surgeries.