A good week for chlorhexidine

All modern hospitals take active steps to protect patients from hospital acquired infections⇑. Two strategies, one specific to Staphylococcus aureus and one more general, have received support from recent randomised trials. In the first, nasal mupirocin and bathing with chlorhexidine soap helped prevent S aureus infections in nasal carriers of the pathogen who were admitted to internal medicine, cardiothoracic surgery, vascular surgery, orthopaedic, gastrointestinal surgery, or general surgery wards (3.4% (17/504) v 7.7% (32/413) in the placebo group; relative risk of S aureus infection 0.42, 95% CI 0.23 to 0.75). Carriers were identified with a rapid real time polymerase chain reaction (PCR) assay. Around one in five of the patients screened was a carrier.

In the second trial, skin preparation with chlorhexidine in alcohol prevented more surgical site infections than skin preparation with 10% povidone iodine in patients having mostly abdominal surgery (9.5% (39/409) v 16.1% (71/440); relative risk 0.59, 0.41 to 0.85). Patients whose skin was prepared with chlorhexidine in alcohol had fewer superficial infections (0.48, 0.28 to 0.84) and deep incisional infections (0.33, 0.11 to 1.01).

Chlorhexidine skin preparation is already recommended for preventing infections associated with intravascular catheters, says an editorial (p 75). Mounting evidence suggests it should replace povidone iodine as the antiseptic of choice before surgery too, particularly abdominal surgery.

Doctors shouldn’t fear online review by patients

Doctors are nervous about being judged by their patients in public. Being rated online invokes the same kind of stomach churning anxiety as fighting your way through a desperate crowd of peers to search for your name on a “pass” list for final exams posted on a notice board, writes one doctor from the US.

Opportunities to rate doctors online are multiplying, however, and their popularity means that they are unlikely to go away. Type your name into Google and you could find …