Cost-effectiveness analysis of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis

Lynch, William T.; Davey, Peter; Malek, Mo; Byrne, D. J.; Napier, A.

doi:10.1016/0195-6701(92)90074-v

Cited by 65 publications

(19 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A short-term suppression rate of 83% after multiple doses of nasal mupirocin was achieved in one randomized, placebo-controlled trial of 891 S. aureus colonized patients, resulting in a statistically significant reduction of invasive S. aureus infection [9]. Several controlled trials suggest a reduction in SSI with the use of pre-operative topical antiseptics [10, 11]. When nasal mupirocin was combined with use of chlorhexidine soap in a randomized, double-blind, placebo-controlled trial including 808 S. aureus colonized surgical patients, a significant reduction in deep S. aureus SSI was realized [12].…”

mentioning

confidence: 99%

Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution

Phillips

Rosenberg

Shopsin

et al. 2014

Infect. Control Hosp. Epidemiol.

137

130

View full text Add to dashboard Cite

Background Treatment of Staphylococcus aureus colonization prior to surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone iodine solution may provide an alternative to mupirocin. Methods We conducted an investigator initiated, open label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical 2% chlorhexidine gluconate (CHG) wipes with either twice daily application of mupirocin 2% ointment for the 5 days prior to surgery or two 30 second applications of povidone iodine 5% solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery caused by any pathogen or S. aureus. Results In the intent-to-treat analysis, a deep SSI developed after 14 of 855 surgeries in the mupirocin group and 6 of 842 surgeries in the povidone iodine group; S. aureus deep SSI developed after 5 surgeries in the mupirocin group and 1 surgery in the povidone iodine group. In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgeries in the mupirocin group and 0 of 776 surgeries in the povidone iodine group. Patients found to be S. aureus colonized before surgery were more likely to have a S. aureus deep SSI (OR 6.79; 95% CI 1.1–41.2; p=0.02). Conclusions Nasal povidone iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI.

show abstract

mentioning

confidence: 99%

Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution

Phillips

Rosenberg

Shopsin

et al. 2014

Infect. Control Hosp. Epidemiol.

137

130

View full text Add to dashboard Cite

show abstract

“…The chlorhexidine skin cleanser consistently reduced staphylococcal colony counts in a prospective randomized observer‐blinded study, 14 but an analysis of randomized controlled trials comparing antiseptic preparations with nonantiseptic preparations for preoperative showering showed no difference in the rate of SSIs 15 . In addition, a cost‐effectiveness analysis revealed that preoperative whole‐body disinfection with a chlorhexidine detergent is not a cost‐effective treatment for reducing wound infection 16 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Methicillin-Resistant Staphylococcus aureus Screening in Mohs Surgery Appears to Decrease Postoperative Infections

Cordova¹,

Grenier²,

Chang³

et al. 2010

Dermatologic Surgery

View full text Add to dashboard Cite

show abstract

“…In some studies, several antiseptic preoperative showers or baths have been associated with reduced postoperative infection rates, but in others, no differences were observed [49][50][51][52][53]. Whole-body washing with chlorhexidine-containing detergent has been shown to reduce infections among neonates [54], but risks of absorption and safety preclude this practice from routine care.…”

Section: Does Skin Cleansing Reduce Risk Of Infection?mentioning

confidence: 99%

Skin Hygiene and Infection Prevention: More of the Same or Different Approaches?

Larson

1999

Clinical Infectious Diseases

268

136

View full text Add to dashboard Cite

The purpose of this article is to review research indicating a link between hand hygiene and nosocomial infections and the effects of hand care practices on skin integrity and to make recommendations for potential changes in clinical practice and for further research regarding hand hygiene practices. Despite some methodological flaws and data gaps, evidence for a causal relationship between hand hygiene and reduced transmission of infections is convincing, but frequent handwashing causes skin damage, with resultant changes in microbial flora, increased skin shedding, and risk of transmission of microorganisms, suggesting that some traditional hand hygiene practices warrant reexamination. Some recommended changes in practice include use of waterless alcohol-based products rather than detergent-based antiseptics, modifications in lengthy surgical scrub protocols, and incorporation of moisturizers into skin care regimens of health care professionals.

show abstract

Cost-effectiveness analysis of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis

Cited by 65 publications

References 18 publications

Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution

Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution

Preoperative Methicillin-Resistant Staphylococcus aureus Screening in Mohs Surgery Appears to Decrease Postoperative Infections

Skin Hygiene and Infection Prevention: More of the Same or Different Approaches?

Contact Info

Product

Resources

About