In a study comparing PI to iodine povacrylex in alcohol solution for skin selleck chem Carfilzomib preparation prior to epidural catheter insertion, iodine povacrylex in isopropyl alcohol solution resulted in more rapid reduction of positive skin cultures, longer duration of action, and lower absolute numbers of organisms cultured from the skin.82 A common factor noted in many recent studies is the increased effectiveness in antimicrobial agents when they are combined with alcohol. Although ethanol preparations have excellent antimicrobial profiles, caution must be taken to avoid the risk of fire associated with inadequate drying of these alcohol-based products.

Any surgical preparation containing alcohol should be allowed to fully dry (> 3 min) to eliminate the risk of fire with the use of electrocautery, and care should be taken to avoid these preparations in especially hirsute patients, as copious amounts of hair interferes with the drying process and fires have been reported.83 Preparation Comparison Few randomized studies have compared iodine- to chlorhexidine-based antiseptics for preoperative skin preparation. A recent trial by Swenson and colleagues84 prospectively compared skin preparation using PI scrub-paint combination with alcohol, 2% chlorhexidine, and 70% alcohol and iodine povacrylex in isopropyl alcohol in all general surgery patients over an 18-month period (6 months for each product) at a single institution. This study demonstrated a 2.5% absolute risk reduction for all SSIs when iodine povacrylex in isopropyl alcohol was used as compared with either PI or chlorhexidine and alcohol.

Overall, the evidence does seem to suggest a benefit of preparations combining chlorhexidine or iodine formulations with alcohol, compared with chlorhexidine or iodine formulations alone. Further, when comparing solutions, care needs to be taken to avoid confusing older PI products with newer film-forming iodine povacrylex in alcohol formulations. Finally, even among the different iodine, chlorhexidine, and alcohol families, effectiveness varies depending on concentration, temperature, level of acidity, the particular germ or virus, contact time, and dry versus wet states. Conclusions Methods aimed at prevention of infection in the operating room have varying levels of data to substantiate their practice, in some cases vetted by strong randomized, controlled trials showing clear benefit, whereas in others propagated through lore or common sense.

Either way, awareness of the important implications of SSI for patient health and costs of care is paramount for any surgeon, and surveilling one��s own practices in the operating room with respect to the existing literature is an important step in controlling infection and maximizing beneficial outcomes. Main Points Surgical site infection (SSI) accounts for 15% of Brefeldin_A all nosocomial infections and, among surgical patients, represents the most common nosocomial infection.