Cluster‐randomized crossover trial of chlorhexidine–alcohol versus iodine–alcohol for prevention of surgical‐site infection (SKINFECT trial)

Abstract

Background: Surgical-site infection (SSI) is a serious surgical complication that can be prevented by preoperative skin disinfection. In Western European countries, preoperative disinfection is commonly performed with either chlorhexidine or iodine in an alcohol-based solution. This study aimed to investigate whether there is superiority of chlorhexidine-alcohol over iodine-alcohol for preventing SSI. Methods: This prospective cluster-randomized crossover trial was conducted in five teaching hospitals. All patients who underwent breast, vascular, colorectal, gallbladder or orthopaedic surgery between July 2013 and June 2015 were included. SSI data were reported routinely to the Dutch National Nosocomial Surveillance Network (PREZIES). Participating hospitals were assigned randomly to perform preoperative skin disinfection using either chlorhexidine-alcohol (0⋅5 per cent/70 per cent) or iodine-alcohol (1 per cent/70 per cent) for the first 3 months of the study; every 3 months thereafter, they switched to using the other antiseptic agent, for a total of 2 years. The primary endpoint was the development of SSI. Results: A total of 3665 patients were included; 1835 and 1830 of these patients received preoperative skin disinfection with chlorhexidine-alcohol or iodine-alcohol respectively. The overall incidence of SSI was 3⋅8 per cent among patients in the chlorhexidine-alcohol group and 4⋅0 per cent among those in the iodine-alcohol group (odds ratio 0⋅96, 95 per cent c.i. 0⋅69 to 1⋅35). Conclusion: Preoperative skin disinfection with chlorhexidine-alcohol is similar to that for iodine-alcohol with respect to reducing the risk of developing an SSI.

Why are we still using antibiotic prophylaxis in elective laparoscopic cholecystectomy for the low-risk groups? a review of literature

“…38 Charehbili et al stated that the efficacy of chlorhexidinealcohol and iodine-alcohol with respect to minimizing the risk of developing an SSI is similar. 39 Darouiche et al reported that preoperative skin preparation with chlorhexidine-alcohol reduced the incidence of SSI by 41% as compared to aqueous povidone-iodine which is most commonly used in the United States of America. Though both are broad-spectrum antimicrobial, chlorhexidine-alcohol's more rapid action, persistent activity despite exposure to bodily fluids, and residual effect provides better protection.…”

“…12 Meticulous preoperative skin preparation is one of the important local factors to prevent the occurrence of SSI. 12,39 Alvarezl et al stated that the aim of the skin preparation is to paint rather than washing the patient with the antiseptic solution. The duration of the application of antiseptic solution depends on the nature of the solution and manufacturer's recommendation but the general consensus is to prepare the skin for at least 3 minutes or allow it to dry completely before incision.…”

The Utility of Perioperative Products for the Prevention of Surgical Site Infections in Total Knee Arthroplasty and Lower Extremity Arthroplasty: A Systematic Review

“…Of these, four studies compared alcohol-based preparations of chlorhexidine and povidoneiodine. [104][105][106][107] Based on these three of these studies, [104][105][106] alcohol-based povidone-iodine outperforms alcohol-based chlorhexidine in reducing the risks of SSIs and wound complications.…”

Cluster-randomized crossover trial of chlorhexidine–alcohol versus iodine–alcohol for prevention of surgical-site infection (SKINFECT trial)

“…Small changes in the specification of the within‐cluster–within‐period correlation, or the within‐cluster–between‐period correlation, can increase the required number of clusters. Thus, as the above‐mentioned correlation parameters were not reported by Charehbili et al ,. the number of clusters required may be larger than that used in the study.…”

“…We read with interest the work of Charehbili and colleagues, which ‘aimed to investigate whether there is a superiority of chlorhexidine–alcohol over iodine–alcohol for preventing SSI’.…”