Post-Operative Infection Associated with Sterile Prep Solutions for Cutaneous Surgery

Background Factors to be considered when selecting an optimal sterile prep solution prior to skin surgery include the underlying health status of the patient, the expected extent of the surgery, the anatomic location of the tumor to be removed or planned reconstruction, and the inherent effectiveness of the prep solution. Recently, it has been suggested that different prep solutions may pose varying risks to patients. Methods Comparison of data from a multicenter prospective cohort study of Mohs micrographic surgery of the head and neck was analyzed to determine whether different prep solutions were associated with different rates of adverse events, particularly postoperative infection. Results The risk of post-operative infection varied based on the surgical prep solution used. The proportion of those who had an infection in each sterile prep group was significantly different (χ2 [4, N=17459]=91.3223, p<.0001). Surgical cases pre-treated with chlorhexidine sterile prep or Techni-care surgical scrub were associated with the lowest rate of infection (0.06% for both preps), while those with povidone iodine were associated with highest rate (1.3%). Discussion This study is the first comparison of clinical effectiveness of prep solutions in a large prospective sample. Moreover, the differences detected are clinically significant in that they confirm that chlorhexidine is a safe and effective prep solution for cutaneous surgery of the head and neck.