Intranasal white petrolatum versus chlorhexidine to reduce postoperative infections in dermatologic surgery

INTERVENTION: Referrals to the Skin Centre for excision of skin cancers will be selected for possible inclusion by one of five participating Consultant Dermatologists. Eligible and consenting patients will at the time of consultation for surgery, fill in a short questionnaire for demographic data and have a nasal swab to assess staphylococcus aureus carriage. The patients will be randomised to either intranasal white petrolatum, 2% chlorhexidine or normal saline to the anterior nares. Five days prior to elective surgery, all patients will apply one of three treatments (depending on randomisation) to the anterior nares twice daily. In the chlorhexidine arm and the normal saline arm, this will be in the manner of a soaked cotton bud whereas in the white petrolatum arm, this will be in the manner of a cotton bud application. All patients will have their wound assessed at the time of suture removal (expected range: 5 – 14 days depending on type of surgery) or if any clinical signs of wound infection occur outside this time frame (up to one month post‐surgery). All infected wounds will be swabbed. The incidence of wound infection will be collected and a comparison will be made to the incidence of wound infection in patients being treated with intranasal white petrolatum, 2% chlorhexidine and individuals using intranasal normal saline. CONDITION: Incidence of postoperative wound infections Prevalance of staphylococcus aureus carriage Skin Cancer PRIMARY OUTCOME: To assess the efficacy of intranasal application of white petrolatum or chlorhexidine for reducing wound infections. The incidence of wound infections in the group using white petrolatum or chlorhexidine in the anterior nares (nostrils) will be compared to the incidence of wound infections in the group using normal saline. SECONDARY OUTCOME: To determine the prevalance of nasal carriage of staphylococcus aureus. The number of nasal swabs being positive (positive culture for growth) for staphylococcus aureus amongst the entire study population will be reported. To determine which patients would benefit most from this approach if proven to be effective. A subgroup analysis would be performed to determine if there are any patient related factors (eg. Age, recent hospitalisation etc) which would place the patient at high risk for intranasal staphylococcus aureus carriage or high risk of post‐operative wound infections. To prove the cost‐effectiveness of this method to reduce wound infections. The cost of intranasal white petrolatum and 2% chlorhexidine would be compared against the cost of managing post‐operative wound infection. INCLUSION CRITERIA: Patients scheduled for elective dermatologic surgery for removal of skin cancer.