Chlorhexidine-alcohol outperformed povidone-iodine in preventing surgical site infections in a head-to-head comparison led by Rabih O. Darouiche, MD, professor in the center for prostheses infection at Baylor College of Medicine in Houston, Texas.

Researchers prepped 409 patients with chlorhexidine-alcohol scrub and 440 patients with povidone-iodine scrub before clean-contaminated surgeries. The application of chlorhexidine-alcohol reduced the SSI risk by 41% compared to povidone-iodine at 30 days post-op, according to the study, which appears in the Jan. 7 issue of the New England Journal of Medicine. The overall SSI rate was 9.5% in the chlorhexidine-alcohol group vs. 16.1% in the povidone-iodine group.

Both antiseptic agents possess broad-spectrum antimicrobial activity, but the researchers note that chlorhexidine-alcohol's superior protection is related to its more rapid action, residual effect and persistent activity despite exposure to bodily fluids. The study was funded by CareFusion, which makes both types of surgical prep; e-mail medical-affairs@carefusion.com for a copy of the full results.

Linda R. Greene, RN, MPS, CIC, director of infection prevention and control for the Rochester (N.Y.) General Health System, says her clinicians use chlorhexidine for most surgeries, particularly orthopedic and cardiac procedures. "Many clinicians have been waiting for robust evidence published in a reputable peer review journal," she says. "This randomized control study provides evidence to support the use of chlorhexidine."

The cost of chlorhexidine-alcohol is typically $7 to $10 per case compared to less than $1 for a regular povidone-iodine paint, says Ms. Greene. She says chlorhexidine-alcohol is easy to use and quick drying, but its application method is different than the typical prep. Rather than applying in concentric circles, it requires a back-and-forth scrubbing motion, she says. "Additionally," she says, "it cannot be used on mucus membranes because it contains alcohol, so there are limitations."

Daniel Cook

In the largest study yet conducted on the subject, researchers have found that arthroscopic shoulder surgery presents a viable alternative to open revision surgery in the event that rotator cuff repairs fail.

For the study, which appears in the January issue of the American Journal of Sports Medicine, physicians at Rush University Medical Center in Chicago examined 61 patients who'd unsuccessfully undergone rotator cuff repair 1 to 2 years after they followed up the procedure with arthroscopic surgery. In most cases, the patients reported significantly improved pain relief and shoulder function.

"Most studies that have published on revision surgery discuss results of open revision techniques," says Shane Nho, MD, an assistant professor at Rush and co-author of the study. "Typically, results of open revision technique are worse than after the initial failed surgery, but the open clinical studies were performed on larger and more chronic rotator cuff tears. It is encouraging to have a study that presents a revision arthroscopic technique that can decrease pain and improve function."

While six of the patients examined required additional surgery after the arthroscopic procedure, they had already undergone 2 or more operations on their shoulders. The study also found that patients with a severely limited range of motion and, for uncertain reasons, female patients showed less significant outcomes.

David Bernard

Treating patients who are positive for Staphylococcus aureus with antibiotic nasal ointment and chlorhexidine soap reduces the risk of the pathogen infecting the surgical site by nearly 60%, according to a study by Dutch researchers.

Identifying and treating patients who are colonized by S. aureus is an effective way to reduce hospital-acquired infections, suggests the study published in the Jan. 7 issue of the New England Journal of Medicine.

Researchers used rapid polymerase-chain-reaction screening to identify 917 patients in 5 hospitals who had been colonized by a strain of S. aureus susceptible to methicillin and mupirocin. All the patients were scheduled to have inpatient surgery and stay in the hospital for at least 4 days. On their first day in the hospital, half were given mupirocin nasal ointment and asked to bathe with chlorhexidine soap, and half were given placebo ointment and soap. Each group continued treatment for 5 days.

Six weeks after discharge, 3.4% of the patients in the mupirocin-chlorhexidine group had an S. aureus infection at the surgical site, compared to 7.7% in the placebo group.

However, since S. aureus makes up just 25% of all surgical site infections, the overall reduction in SSIs from this treatment is only about 15%, notes Richard P. Wenzel, MD, of the department of internal medicine at the Virginia Commonwealth University in Richmond, in an editorial. He recommends that screening and treatment for S. aureus be reserved for patient populations with a higher risk of infection, such as those with implants and those undergoing open-heart surgery.

Kent Steinriede

Quick: Is there a salesman standing in your operating room, helping your surgeon properly use a new medical device? After all, the salesman may know more about his product than the doctors who use them. Tell us how you feel about medical sales reps working alongside doctors in this week's InstaPoll. We'll report the results in this space next week.

Last week we asked which piece of equipment have you purchased refurbished. Of the 68 responses we received, 24% were for surgical microscopes, 19% for instrument sterilizers, 17% for vital signs monitors and 16% for C-arms. Nearly one-fourth (24%) of respondents said they didn't buy refurbished equipment.

Dan O'Connor