title: Chlorhexidine-alcohol compared with povidone-iodine for surgical-site antisepsis in cesarean deliveries.
abstract: OBJECTIVE
  To estimate the incidence of surgical-site infection with use of chlorhexidine-alcohol compared with povidone-iodine among women undergoing cesarean deliveries.
  
  
  METHODS
  This was a retrospective cohort review of 1,000 consecutive cases in women who underwent cesarean delivery over a 1-year interval. The primary outcome was any surgical-site infection within 30 days (Centers for Disease Control and Prevention criterion).
  
  
  RESULTS
  Mean age and parity were equivalent (29.8±5.9 years; 2.6±1.4). Women were similar regarding baseline characteristics, including acknowledged surgical-site infection comorbidities (body mass index [BMI, calculated as weight (kg)/[height (m)]2], gestational diabetes, smoking; P>.05). Method of skin incision closure was different, with 91% among povidine-iodine compared with 81% among chlorhexidine-alcohol using staples (P<.001). Although the duration of surgical time was higher among chlorhexidine women (67.2 compared with 60.0 minutes; P<.001), fewer women in the chlorhexidine group were classified as having undergone an "urgent" cesarean delivery (29% compared with 46%; P<.001). Concerning surgical-site infection, the overall rate was similar between the two groups (5% [n=25] chlorhexidine and 5.8% [n=29] povidone-iodine; P=.58). In multivariable analysis and after control for potential confounders, odds for surgical-site infection remained similar between the two groups (adjusted odds ratio 0.74, 95% confidence interval 0.41-1.33; P=.32). The only significant predictor of surgical-site infection was duration of cesarean delivery, in which every 1-minute increase in duration increased the odds for infection by 1.3% (adjusted odds ratio 1.013, 95% CI 1.004-1.022; P=.004).
  
  
  CONCLUSIONS
  The single significant predictor of surgical-site infection is operative time. Cleansing with povidone-iodine may be a cost-effective and equally efficacious alternative to chlorhexidine-alcohol among women undergoing cesarean deliveries.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Gulden
authors.initials: G
authors.lastname: Menderes
authors.forename: Nishath
authors.initials: N
authors.lastname: Athar Ali
authors.forename: Kjersti
authors.initials: K
authors.lastname: Aagaard
authors.forename: Haleh
authors.initials: H
authors.lastname: Sangi-Haghpeykar
mesh_terms: D000293:Adolescent; D000328:Adult; D000985:Antisepsis / Q000379:methods*; D002585:Cesarean Section / Q000009:adverse effects*; D002710:Chlorhexidine / Q000008:administration & dosage*; D015331:Cohort Studies; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011247:Pregnancy; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000431:Ethanol; D011206:Povidone-Iodine; D002710:Chlorhexidine