Antimicrobial Trumps Soap and Water in the ICU

The authors launched the study because "the use of antiseptic agents for patient bathing is currently considered controversial."  Previous studies were ambivalent, or if they showed a benefit for chlorhexidine, were criticized for being small, limited, or single-center studies.

And some studies have been negative, especially as a prevention against surgical site infections, when the patient is washed or is asked to wash with chlorhexidine in the hours or day before surgery. 

For example, a meta-analysis of clinical trials published in the American Journal of Infection Control this month by researchers in Singapore, said there is "no appreciable benefit of preoperative whole-body chlorhexidine bathing for prevention of surgical site infections. However, most studies omitted details of chlorhexidine application."

Wong says that work is ongoing with other studies of preoperative showering with chlorhexidine.

There is concern about the expense of chlorhexidine products.

"Some hospitals don't use it because it's more expensive than soap and water," says Michael Edmond, MD, chair of the division of infectious diseases and hospital epidemiologist for Virginia Commonwealth University Medical Center. He says the NEJM report "adds further evidence as to (chlorhexidine's) effectiveness."