Sir:
Surgical-site infection is a potential complication that can occur after any type of surgical procedure. Surgical-site infections are classified into three categories: superficial incisional (involving only skin and subcutaneous tissue), deep incisional (involving deep soft tissue), and organ or space surgical-site infections (involving anatomical areas other than the incision itself that are opened or manipulated in the course of the procedure).1
Clean procedures (nontraumatic; no inflammation encountered; no break in technique; and respiratory, alimentary, or genitourinary tract not entered), which are the procedures most commonly performed by plastic surgeons, are associated with a 1 to 5 percent incidence of surgical-site infection.2 Table 1 ).
Table 1: Characteristics of Chlorhexidine- and Povidone-Iodine–Containing Antiseptic Solutions
There have been several reports in the literature comparing the two most commonly used antiseptic solutions, and the majority of them demonstrate superiority of chlorhexidine over povidone-iodine solutions. The Centers for Disease Control and Prevention recommends that 2% chlorhexidine-based preparations be used to cleanse the site of insertion of vascular catheters to decrease the risk of vascular catheter–related bloodstream infection.3 3
Nine plastic surgery attending physicians, who work in either a private or an academic setting in the metropolitan area of Chicago, Illinois, were contacted and asked what type of antiseptic solution they use for their procedures, excluding the craniofacial ones. Eight of nine (88.8 percent) responded that they prefer povidone-iodine solution, over chlorhexidine, for different reasons, none of which included the available evidence on the efficiency of either one of them.
A randomized controlled trial, published in the November of 2008 issue of Plastic and Reconstructive Surgery , recommended the use of chlorhexidine before elective clean plastic surgery procedures.4
Victor J. Hassid, M.D.
University of Illinois at Chicago
820 South Wood Street
Suite 515 CSN
Chicago, Ill. 60612
REFERENCES
1.Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infections.
Infect Control Hosp Epidemiol. 1992;13:606–608.
2.Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index: National Nosocomial Infections Surveillance System.
Am J Med. 1991;91:152S–157S.
3.Darouiche RO, Wall MJ Jr, Itani KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis.
N Engl J Med . 2010;362:18–26.
4.Veiga DF, Damasceno CA, Veiga-Filho J, et al. Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: A randomized controlled trial.
Plast Reconstr Surg. 2008;122:170e–171e.
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