Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study.
Feet are prone to bacterial contamination. We hypothesized that chlorhexidine scrub and isopropyl alcohol paint provide superior local flora reduction than povidone-iodine scrub and paint. Patients with intact, uninfected skin having clean elective foot and ankle surgery were prospectively enrolled and randomly assigned to skin preparation with povidone-iodine (Group 1) or chlorhexidine scrub and isopropyl alcohol paint (Group 2). Culture swabs (aerobic, anaerobic, acid fast, fungus, and routine antibiotic sensitivity) were taken from all web spaces, nail folds, toe surfaces, and proposed surgical incision sites. One-hundred twenty-seven patients were enrolled (mean age, 46 years; range, 16-85 years). Sixty-seven patients were assigned to Group 1; 60 patients were assigned to Group 2. In Group 1, 53 of 67 patients (79%) had positive cultures; in Group 2, 23 of 60 patients (38%) had positive cultures. These data indicate that chlorhexidine and alcohol provide better reduction in bacterial carriage than povidone-iodine. Based on these data, we recommended chlorhexidine as the surgical preparatory agent for the foot and ankle.


METHODS
Therapeutic study, Level I-1a (significant difference). See the Guidelines for Authors for a complete description of levels of evidence.
Bibbo
Christopher
C
Department of Orthopaedics, Marshfield Clinic, Marshfield, WI 54449, USA. bibbo.christopher@marshfieldclinic.org
Patel
Dipak V
DV
Gehrmann
Robin M
RM
Lin
Sheldon S
SS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000382:microbiology / Q000601:surgery; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001419:Bacteria / Q000187:drug effects / Q000254:growth & development; D002710:Chlorhexidine / Q000008:administration & dosage*; D015169:Colony Count, Microbial; D019317:Evidence-Based Medicine; D005260:Female; D005528:Foot / Q000382:microbiology / Q000601:surgery; D005658:Fungi / Q000187:drug effects / Q000254:growth & development; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011206:Povidone-Iodine / Q000627:therapeutic use; D012867:Skin / Q000187:drug effects* / Q000382:microbiology; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; D002710:Chlorhexidine