title: Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis.
abstract: BACKGROUND
  Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine.
  
  
  METHODS
  We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections.
  
  
  RESULTS
  A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups.
  
  
  CONCLUSIONS
  Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA. rdarouiche@aol.com
authors.forename: Rabih O
authors.initials: RO
authors.lastname: Darouiche
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.forename: Mary F
authors.initials: MF
authors.lastname: Otterson
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Webb
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Carrick
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Miller
authors.forename: Samir S
authors.initials: SS
authors.lastname: Awad
authors.forename: Cynthia T
authors.initials: CT
authors.lastname: Crosby
authors.forename: Michael C
authors.initials: MC
authors.lastname: Mosier
authors.forename: Atef
authors.initials: A
authors.lastname: Alsharif
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
mesh_terms: D019840:2-Propanol / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000704:Analysis of Variance; D000891:Anti-Infective Agents, Local / Q000009:adverse effects / Q000627:therapeutic use*; D000985:Antisepsis / Q000379:methods; D002710:Chlorhexidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control; D004338:Drug Combinations; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011206:Povidone-Iodine / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D012867:Skin / Q000382:microbiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine