Archive Patient Skin Preparation 2014

The Science of Skin Prepping

What does the latest literature recommend on skin antisepsis and hair removal?

David Bernard, Senior Associate Editor


skin prepping CLOTH CARE Do CHG wipes' antimicrobial effect have an impact on SSI rates?

Recent years have seen the publication of several landmark studies on pre-operative skin preparation's role in reducing bacteria and preventing surgical site infections, but these have by no means been the last word on the subject. Here's a recap of some of the latest thinking on skin prepping agents, pre-op bathing and hair removal.

The effectiveness of agents
The Darouiche study (see "Chlorhexidine-Alcohol Wins Face Off vs. Povidone-Iodine"), published in the New England Journal of Medicine 4 years ago (, joined a quickening drumbeat of research recommending chlorhexidine gluconate for skin antisepsis before general and orthopedic surgeries due to its high antibacterial efficacy and surgical site reduction rates. Critics of the study have questioned its balance, however, since it pitted a 2% CHG and 70% isopropyl alcohol product against an aqueous solution of 10% povidone-iodine.

In "The Forgotten Role of Alcohol," published online in the journal PLoS One in September 2012 (, researchers from the KK Women's and Children's Hospital in Singapore pointed out this discrepancy in a range of studies. "We found good evidence favouring chlorhexidine-alcohol over aqueous competitors, but not over competitors combined with alcohols," they wrote. They also noted that several studies "attributed outcomes solely to chlorhexidine when the combination with alcohol was in fact used. ... The role of alcohol has frequently been overlooked in evidence assessments."

When even competitions can be arranged, recent clinical comparisons of skin prepping agents have seen neck-and-neck finishes — that is, if any conclusions can be reached — as shown by the following studies.

  • Citing contradictory results in studies touting the effects of CHG-alcohol products, researchers from the Washington State Surgical Care and Outcomes Assessment Program compared 4 agents — CHG, CHG with isopropyl alcohol, povidone-iodine, and iodine-povacrylex in isopropyl alcohol — on 7,669 patients in clean-contaminated surgeries at four Seattle-area facilities. As reported in the Journal of the American College of Surgeons' Nov. 27, 2013 issue, the study "did not demonstrate superiority of any commonly used skin antiseptic agent in reducing the risk of SSI, nor did it find any unique effect of isopropyl alcohol. These results do not support the use of more expensive skin preparation agents." (
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