Page 71
I N F E C T I O N
P R E V E N T I O N
STRONG SUPPORT
Don't Overlook Alcohol's Assistance
The case for chlorhexidine gluconate's antiseptic superiority seems to grow stronger and stronger each time a clinical comparison of skin prep agents is published. But CHG isn't always working alone and other preps don't have to, facts that infection prevention experts say may be misrepresented in many studies.
For "The Forgotten Role of Alcohol," a study published online by the journal PLoS One on Sept. 5, 2012, researchers from the KK Women's and Children's Hospital in Singapore reviewed the wealth of medical literature on CHG's effects with an eye on study design, antiseptic composition, outcomes and attribution.
"We found good evidence favoring chlorhexidine-alcohol over aqueous competitors, but not over competitors combined with alcohols," they wrote (tinyurl.com/kc98ehx). More than a few studies "attributed outcomes solely to chlorhexidine when the combination with alcohol was in fact used," and ambiguous attribution was common. "Perceived efficacy of chlorhexidine is often in fact based on evidence for the efficacy of the chlorhexidine-alcohol combination. The role of alcohol has frequently been overlooked in evidence assessments."
One organization that hasn't overlooked alcohol's supporting role is the Institute for Healthcare Improvement's Project JOINTS (tinyurl.com/otmkt4w), which aims to wipe out SSIs from orthopedic surgery. It recommends that alcohol should be an ingredient in whichever prep you're using.
— David Bernard
--------------------------------
Drawing conclusions
In a comparison of skin prep products, the designation "most effective" can be quantified by clinical research in one of two ways. First, which prep has the highest antimicrobial efficacy rate (in the studies
