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To wash or not to wash: that is the question: Commentary on an article by S.J. van Meurs, MD, et al.: "Selection of an optimal antiseptic solution for intraoperative irrigation. An in vitro study".

There has been heightened interest in the prevention and minimization of perioperative infections1. These efforts have included, but are not limited to, the NSQIP (National Surgical Quality Improvement Program) and SCIP (Surgical Care Improvement Program). Notwithstanding this heightened interest, the substantial morbidity and increased costs of perioperative infections are best avoided.

A few recent clinical studies have indicated decreased infection rates in surgical procedures in which the surgeons employed intraoperative irrigation with an antiseptic solution. Brown et al. reported a reduction in the ninety-day infection rate in hip and knee arthroplasties from 0.97% (in wounds irrigated with 1 L of normal saline solution prior to closure) to 0.15% with a three-minute irrigation with dilute (0.35%) Betadine and a 10% povidone-iodine skin application prior to final closure2. Cheng et al. performed a prospective randomized spine surgery trial and reported no infections in 208 patients following irrigation with dilute (3.5%) Betadine compared with one superficial and six deep infections in 206 patients treated without irrigation (p < 0.01)3. However, there have been few such studies, and the antiseptic agents and their concentration have varied among the studies, presumably on the basis of which antiseptic solutions were readily available and on empirical practices. To our knowledge, there have been no in vivo studies comparing the efficacy or toxicity …