Chlorhexidine-alcohol versus Povidone-Iodine-alcohol for surgical site antisepsis in caesarean section

Abstract

Background: Caesarean section is one of the most common procedures performed. Recent studies found that surgical-site infection (SSI) was the most common healthcare-associated infection. Authors hypothesized that optimization of preoperative skin antisepsis may decrease postoperative infections. The objective was to establish the efficacy of chlorhexidine-based antiseptic protocol versus povidone-iodine protocol in reducing SSI for patients undergoing caesarean deliveries.Methods: This is a randomized prospective study conducted from April 2017 to September 2017 at a tertiary care center in India. Women who underwent caesarean sections were allocated into either group. Enrolled patients were randomly assigned to have the surgical site painted with chlorhexidine-alcohol preparation or painted with a solution of 10% povidone-iodine and then with surgical spirit. The outcomes were any SSI occurring within a week or during the 30 day follow up period of the surgery including any of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions.Results: A total of 560 subjects (273 in the chlorhexidine group and 287 in the iodine group) qualified for the study. The number of surgical-site infection was significantly lower in the chlorhexidine group than in the iodine group (6.95% vs. 14.28%; P=0.005). Chlorhexidine–alcohol was significantly more protective than iodine-alcohol against both superficial incisional infections (5.49% vs. 10.10%, P=0.03) and deep incisional infections (1.46% vs. 4.18%, P=0.04).Conclusions: This study highlighted that Chlorhexidine-alcohol provided superior skin antisepsis in comparison to povidone iodine-alcohol.

Randomised Controlled Trials of Alcohol-Based Surgical Site Skin Preparation for the Prevention of Surgical Site Infections: Systematic Review and Meta-Analysis

“…Fifty-nine publications were subsequently retrieved for full-text review, of which 46 did not meet the inclusion criteria. Thirteen studies were eligible for inclusion in the review ( n = 6023 participants) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Characteristics of the included studies are outlined in Table 1 .…”

“…All thirteen included trials compared alcohol-based chlorhexidine to alcohol-based iodophor preparations. The concentration of the chlorhexidine was 0.5% in six trials [ 17 , 19 , 20 , 23 , 24 , 29 ] and 2% in six trials [ 18 , 22 , 25 , 26 , 27 , 28 ]. In one trial [ 21 ], the concentration of the agents was not specified.…”

“…The alcohol concentration was documented in eight trials and ranged from 70–74%. In one trial [ 20 ], the iodophor and alcohol was applied in a two-step process.…”

“…Participant follow-up ranged from 3 days to 365 days. Six of the studies applied the CDC criteria for defining SSI [ 18 , 20 , 21 , 23 , 27 , 29 ]. In three studies, infections were defined based on clinical diagnosis [ 17 , 24 , 28 ] and in four studies, no definitions for infection were provided [ 19 , 22 , 25 , 26 ].…”

“…The risk of bias was assessed as low in two studies [ 23 , 27 ] ( Figure 4 A). In nine trials, the risk of bias was unclear, particularly the risk of performance and detection bias [ 17 , 18 , 19 , 20 , 21 , 25 , 26 , 28 , 29 ]. There was high risk of selection bias determined in the trials by Rodrigues et al [ 24 ] and Ostrander et al [ 22 ] ( Figure 4 A).…”