Study: Costlier surgery-site antiseptic proves worth it

[Harrison]

By CINDY GEORGE
Copyright 2010 Houston Chronicle

Jan. 6, 2010, 8:52PM

A study led by a Houston researcher has found that a less-popular, but more-expensive surgery-site antiseptic is more effective at reducing infections than the most commonly used product.

The research, led by Dr. Rabih Darouiche and published in today's edition of the New England Journal of Medicine, is prompting a local hospital — one of six across the country to participate in the seven-year study — to change its pre-surgery skin cleanser.

The first-of-its-kind study compared two surgery-site antiseptics — including the one most widely used in the United States to cleanse patients' skin before surgery — and found that the more expensive, less popular product reduces infections about 40 percent more than the other product does.

Research sites included Ben Taub General Hospital and the Michael E. DeBakey VA Medical Center.

Every year in the United States, 300,000 to 500,000 patients have surgical-site infections. Twenty to 30 percent of those infections are caused by staph and more than half of those infections come from bacteria already on the patient's skin.

The more-effective antiseptic — chlorhexidine-alcohol — is used for about 10 percent of U.S. surgeries, but the slightly higher price pales in comparison to the savings for avoiding costly infections, Darouiche said.

Since 2002, the Centers for Disease Control and Prevention has recommended chlorhexidine-alcohol to reduce vascular catheter-association bloodstream infections. Studies have shown the antiseptic is more effective than povidone-iodine for cleaning the entry site for those tiny needles used to move fluids through patients.

“This is a very powerful, quick and practical approach to prevent surgical-site infections,” said Darouiche, who practices at the DeBakey VA Medical Center and teaches at Baylor College of Medicine. The study included 849 patients.

Most VA hospitals continue to use povidone-iodine to cleanse surgical sites, but because of the study, the DeBakey VA Medical Center is in the process of switching to chlorhexidine-alcohol, Darouiche said.

“The reason they use it is not just because it has been used for decades, but they use it because it's essentially cheap,” he said. An average surgery would require a $12 chlorhexidine-alcohol product. A similar povidone-iodine skin preparation costs about $3.

“You can save anywhere from $10 to $400 (in infection treatment costs) for each extra dollar you spend,” said Darouiche, an internist whose specialties include infectious disease and spinal cord injury medicine.

Neither officials at the hospitals nor CareFusion — the company that makes both antiseptic products — knew about the study results until they were released Wednesday afternoon, Darouiche said.

The company supplied researchers with ChloraPrep, a chlorhexidine-alcohol preoperative skin preparation, along with another product that contained povidone-iodine. The study was almost entirely funded through grants and consulting fees to researchers from Cardinal Health, which recently spun off CareFusion.

[Harrison]

Better antiseptic curbs post-surgery infections

By STEPHANIE NANO, Associated Press Writer Stephanie Nano, Associated Press Writer Wed Jan 6, 5:00 pm ET

NEW YORK – Looks like doctors aren't the only ones who should scrub before surgery. Bathing patients with an antiseptic and squirting medicated ointment up their noses dramatically cut the rate of dangerous staph infections afterward, researchers found.

A second study found the antiseptic did a better job of preventing infections than the reddish-brown iodine solution that's been used for decades to swab the skin before an operation.

Infections are a vexing problem for hospitals. Some 30 million surgical procedures are done each year, and up to a half million Americans develop surgical-site infections, mostly from staph bacteria.

While attention has been focused on ways to stop health care workers from spreading bugs, patients can also contaminate themselves with the germs they harbor in their noses or on their skin.

"A lot of people think it's all from the outside world, but these are your own germs," said Dr. Robert Weinstein, an infectious disease expert at Cook County's Stroger Hospital in Chicago.

Two new studies, published in Thursday's New England Journal of Medicine, tried different approaches to killing those bacteria to see if that reduced the number of post-surgery infections.

U.S. researchers tested a newer antiseptic against the iodine solution commonly used to prep surgery patients and found it cut all surgical-site infections by 40 percent. The study's leader, Dr. Rabih Darouiche, of the Michael DeBakey VA Medical Center in Houston, and other experts expect the newer antiseptic to replace iodine.

In the Netherlands, where the newer antiseptic prep is already used, researchers screened patients and treated those who had staph bacteria to see if there was any additional benefit. Treatments with nasal ointment and antiseptic baths reduced staph infections by nearly 60 percent compared to dummy treatments.

"This is the single most effective way of preventing surgical-site infections," said researcher Dr. Henri Verbrugh of the Erasmus University Medical Center in Rotterdam.

The Dutch researchers and others had tested the staph-killing ointment before with mixed results. They attribute the positive outcome to the development of a rapid screening test, the addition of the antiseptic bath and continuing the treatment for five days.

The study was done at five hospitals in the Netherlands and involved 917 mostly surgical patients who tested positive for staph bacteria when they were admitted. They were treated with either mupirocin ointment twice daily and daily baths with antiseptic chlorhexidine soap or dummy ointment and soap.

Over the next six weeks, about 3 percent of the treated group had staph infections compared to about 8 percent in the dummy treatment group. The treatment also cut average hospital stays by two days.

The U.S. study at six hospitals included 849 patients who were having surgeries with a moderate risk for infection. The incision area was cleaned with either the iodine scrub or a mixture of chlorhexidine and alcohol. A month later, the overall infection rate in the chlorhexidine group was about 10 percent compared to 16 percent for iodine.

Darouiche said the two preps both work against a variety of germs but the newer blue-tinted antiseptic works quicker and longer. It costs more — on average $12 vs. $3 for the iodine prep — but Darouiche said the expense is outweighed by the thousands saved by preventing costly infections. Dr. Richard Wenzel, who wrote an editorial on the studies, said the U.S. research supports switching antiseptics. But he said the pre-surgery screening should be for those at higher risk of infection, including patients having heart surgery or getting an implant.

Wenzel, of Virginia Commonwealth University in Richmond, Va., said patients can play a role by asking about infection rates connected with their hospital and doctor. Prevention guidelines call for patients to get antibiotics right before surgery and for hair to be clipped, not shaved. The two studies "offer remarkably safer strategies for all patients who require surgery," he wrote.


The U.S. study was funded by CareFusion Corp., formerly part of Cardinal Health Inc., which makes the antiseptics tested. The researchers report getting grants and consulting fees from the company, and one is a company employee. The Dutch study was funded by a number of drugmakers; some of the researchers receive advisory board and lecture fees from them.
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On the Net: New England Journal: http://www.nejm.org