Women who deliver babies via cesarean section (C-section) surgery may develop infections of the incision, and this news release describes research that shows an alternative combination of skin-cleaning agents prior to surgery may prevent those infections more effectively. The randomized study, which took place at a single hospital, included more than 1,000 patients. It showed that patients prepped for surgery with chlorhexidine-alcohol had a 4% infection rate compared with 7.3% for patients prepped with iodine-alcohol.
This well-written news release meets almost all of our criteria for accuracy and includes helpful context about the price of infection care. One area of concern is the recommendation to change the standard of care based on just one study in a single hospital. While it’s a strong study, perhaps it should be replicated in an unrelated setting and be blinded as well as randomized before recommending a change in practice.
Like another release we recently reviewed on chocolate for preventing preeclampsia, this one focused on a study presented at the Society for Maternal-Fetal Medicine’s annual meeting. This quality of this well-crafted release is a nice contrast to the previous one that was graded 0 stars.
Delivering babies via C-section is common in the United States, and an estimated 1.3 million women delivered that way in 2013. Between 5 and 12 percent of those deliveries included an infection. Shortening post-surgical pain and reducing the risk of infection could improve many recoveries.
We gave the release a passing grade on cost for including context on the cost of an infection.
“An estimated 1.3 million women in the U.S. delivered their babies by C-section in 2013, with surgical-site infections complicating 5 to 12 percent of those deliveries. The average cost of treating those cesarean-related infections in the hospital is $3,500 and may be much higher for severe infections.”
Our wish list for this release might include whether chlorhexidine is any more expensive (or cheaper) than the standard of care and what the cost is for treating an infection outpatient. These are details that would have added to the quality of the release. However, infections are costs that can be prevented, and that is the main issue which the release covers well.
The story quantifies the benefits well, explaining that a randomized-controlled trial showed “patients in the chlorhexidine-alcohol group developed significantly fewer infections than patients in the iodine-alcohol group. Those who received the chlorhexidine-alcohol combination had a 4 percent infection rate, which is nearly half that of the patients who received the iodine-alcohol combination — 7.3 percent.”
The news release includes both relative and absolute numbers — a big plus. The absolute numbers included the number of women who developed infections after being treated with either chlorhexidine-alcohol (23) or iodine-alcohol (42) and the size of their co-hort (572 vs. 575).
The news release doesn’t mention any harms associated with either of the antiseptics used in the study. If there were no skin reactions, or some with one but not the other, it would be good to note that. This is a minor omission.
The release did a good job of explaining the quality of the evidence from this randomized controlled trial. Here is one paragraph about that evidence.
“The clinical trial included 1,147 patients who underwent cesarean sections at Barnes-Jewish Hospital from 2011 to 2015. Of 572 patients randomly assigned to receive the chlorhexidine-alcohol combination, 23 developed an infection at the site of the surgery within 30 days of the procedure. Of 575 patients who randomly received the iodine-alcohol combination, 42 developed a surgical-site infection.”
One thing that was discussed in the study that would have made the release better had it been included was the differentiation between minor and severe infections.
There’s no disease mongering here.
The release clearly states the funding sources. There were no apparent conflicts.
The study compares an alternative method of skin preparation to the current standard and also mentions antibiotics. Soap and water could be another alternative, as could foregoing an elective C-section, but it’s probably too big a digression to mention these when reporting on a head-to-head study on antiseptics.
We believe both skin-cleaning agents are widely available. So while the release never explicitly addresses availability, we don’t dock points for this.
The release explained that other studies have examined skin-prep, but this one was the first to directly compare dual-element preps for C-sections. Here is an excerpt:
“Past trials comparing antiseptics before surgery included relatively few participants and often compared a chlorhexidine-alcohol combination with iodine alone. These studies could not determine whether the worse performance of iodine alone was due to the chlorhexidine, the alcohol or the combination.”
The release does not resort to unjustifiable language. It uses a measured tone and acknowledged a potential weakness when pointing out that the study was limited to a single hospital.
The call for a change in practice, which in our opinion may be premature based on one single-site study, is offered as an opinion expressed by the senior author:
“This study is a tremendous addition to the literature on preventing surgical-site infections after cesarean. There are few circumstances when a single study should change our practice. But based on the biological plausibility and the striking reduction in surgical-site infections with chlorhexidine, this is one of those circumstances.”
We think experts can be given latitude to express a range of opinions in a news release.