A randomized trial of the bactericidal effects of chlorhexidine vs povidone-iodine vaginal preparation

Abstract

BACKGROUND: Precesarean vaginal preparation significantly reduces postpartum infections. Although povidone-iodine is the most commonly used vaginal antiseptic, evidence suggests that chlorhexidine gluconate may be more effective. OBJECTIVE: We aimed to compare the bactericidal effect of chlorhexidine gluconate and povidone-iodine on vaginal bacterial colony counts in pregnancy. MATERIALS AND METHODS: We conducted a prospective randomized controlled trial of vaginal preparation with 0.5% chlorhexidine gluconate vs 10% povidone-iodine vs saline in women undergoing cesarean delivery at !34 weeks' gestation. Women in labor or those with ruptured membranes, chorioamnionitis, abnormal placentation, or allergy to study agents were excluded. Vaginal specimens were collected aseptically in the operating room immediately before and 5e10 minutes after vaginal cleansing with 3 sterile sponge sticks. Our primary outcome was postintervention aerobic and anaerobic bacterial colony counts, assessed by blinded investigators. Two-way analysis of variance with simple-effects analysis and Tukey post hoc test were used for multiple group comparisons. Secondary outcomes included baseline colony counts, change in colony counts, adverse events, and maternal infections.RESULTS: A total of 29 women consented and underwent vaginal preparation with chlorhexidine gluconate (n¼10), povidone-iodine (n¼9), or saline (n¼10). Groups were similar with respect to maternal age, body mass index, race, ethnicity, parity, group B streptococcus status, and gestational age. There were no differences in baseline colony counts. Vaginal preparation with povidone-iodine resulted in lower aerobic and anaerobic colony counts compared with chlorhexidine gluconate and saline (P .01 and P .0001, respectively). Povidone-iodine eliminated more than 99.9% of bacteria, whereas chlorhexidine gluconate and saline eliminated more than 99% and 95% of bacteria, respectively. Although all agents decreased aerobic and anaerobic bacterial counts, 0.5% chlorhexidine gluconate was no more effective than saline in reducing anaerobic bacteria. There were no reported adverse effects or postpartum infections. CONCLUSION: Compared with 0.5% chlorhexidine gluconate, 10% povidone-iodine was more effective in reducing vaginal bacterial colony counts before cesarean delivery.

Irrigation techniques used in spine surgery for surgical site infection prophylaxis: a systematic review and meta-analysis

“…This review identified very little research published related to chlorhexidine solutions. In other surgical specialties such as cardiac, orthopedic, and gynecological surgery, chlorhexidine has been used with minimal evidence of tissue toxicity [43,44]. However, in the case of vaginal preparation PVP-I was shown to be more effective [44].…”

“…In other surgical specialties such as cardiac, orthopedic, and gynecological surgery, chlorhexidine has been used with minimal evidence of tissue toxicity [43,44]. However, in the case of vaginal preparation PVP-I was shown to be more effective [44]. Also, it has been demonstrated that surgeons should be hesitant in mixing chlorhexidine with other antiseptics as precipitate can form and lead to complications [45].…”

A Randomized Controlled Trial of Povidone‐Iodine Versus Chlorhexidine Gluconate With Isopropyl Alcohol for Preoperative Vaginal Antisepsis

“…The researchers had intentionally selected a low CHG concentration for the study (ie, 0.5%) to minimize vaginal burning and irritation; they noted that mild irritation can occur with PI antiseptics. 17 Another study compared the rates of symptomatic urinary tract infection (UTI) after application of either 10% PI or 2% CHG for vaginal antisepsis in 119 patients undergoing urogynecological procedures. 38 The primary outcome reflected the patients' symptoms during the two-week follow-up visit.…”

“… leaves a topical yellow residual stain; 10 may cause chemical burns, 11 skin irritation, 12 and allergic reactions, 13 including anaphylaxis; 14 has minimal persistence; 12,15 is inactivated in the presence of blood and other body fluids, serum proteins, other organic matter, 12,15 and the acidic environment 16 of the vagina; 17 and may be absorbed through the vagina and into the circulatory system 18,19 …”

Surgical site infections in gynecology: the latest evidence for prevention and management

“…One frequently sited rationale is that CHG is not deactivated in the presence of blood. The literature is mixed with regard to which method better prevents of SSI [47 ▪ ,48 ▪ ,49 ▪ ,50]. ACOG supports use of either solution [26].…”