(HealthDay News) – Use of a chlorhexidine-based solution for preoperative skin marking is associated with more erasure of skin markings than an iodine-based alternative, according to a study published in the Jan. 18 issue of The Journal of Bone & Joint Surgery.

Savyasachi C. Thakkar, MD, and Simon C. Mears, MD, PhD, of John Hopkins Bayview Medical Center in Baltimore, photographed preoperative skin markings on 20 patients to evaluate the visibility of black letters and the surgeon’s initials before and after application of a chlorhexidine-based or an iodine-based skin preparation solution. The photographs were assessed quantitatively (marker to skin contrast), before and after application of solutions, and qualitatively (how well 10 surgeons identified the initials and skin markings).

The researchers found that the mean change in contrast level was significantly greater following application of the chlorhexidine-based solution than the iodine-based solution (59.8 vs. 14.9 U). Following preparation with the chlorhexidine-based solution, surgeons were 22 times less likely to find markings acceptable for site identification than after preparation with the iodine-based solution. Surgeons correctly identified significantly more letters in the iodine-based solution group than in the chlorhexidine-based solution group (296 vs. 209 out of 300).

“This prospective randomized clinical trial shows that a chlorhexidine-based skin preparation solution erases surgical site markings more frequently than does an iodine-based solution,” the authors write. “Therefore, care should be taken in site identification when chlorhexidine-based skin-preparation solutions are used.”

One or more of the study authors disclosed financial ties to a third party.

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