Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis.
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.)
Darouiche
Rabih O
RO
Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA. rdarouiche@aol.com
Wall
Matthew J
MJ
Itani
Kamal M F
KM
Otterson
Mary F
MF
Webb
Alexandra L
AL
Carrick
Matthew M
MM
Miller
Harold J
HJ
Awad
Samir S
SS
Crosby
Cynthia T
CT
Mosier
Michael C
MC
Alsharif
Atef
A
Berger
David H
DH
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*
D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine