title: A comparison of chlorhexidine-alcohol versus povidone-iodine for eliminating skin flora before genitourinary prosthetic surgery: a randomized controlled trial.
abstract: OBJECTIVE
  We defined the relevant skin flora during genitourinary prosthetic surgery, evaluated the safety of chlorhexidine-alcohol for use on the male genitalia and compared chlorhexidine-alcohol to povidone-iodine in decreasing the rate of positive bacterial skin cultures at the surgical skin site before prosthetic device implantation.
  
  
  METHODS
  In this single institution, prospective, randomized, controlled study we evaluated 100 consecutive patients undergoing initial genitourinary prosthetic implantation. Patients were randomized to a standard skin preparation with povidone-iodine or chlorhexidine-alcohol. Skin cultures were obtained from the surgical site before and after skin preparation.
  
  
  RESULTS
  A total of 100 patients were randomized, with 50 in each arm. Pre-preparation cultures were positive in 79% of the patients. Post-preparation cultures were positive in 8% in the chlorhexidine-alcohol group compared to 32% in the povidone-iodine group (p = 0.0091). Coagulase-negative staphylococci were the most commonly isolated organisms in post-preparation cultures in the povidone-iodine group (13 of 16 patients) as opposed to propionibacterium in the chlorhexidine-alcohol group (3 of 4 patients). Clinical complications requiring additional operations or device removal occurred in 6 patients (6%) with no significant difference between the 2 groups. No urethral or genital skin complications occurred in either group.
  
  
  CONCLUSIONS
  Chlorhexidine-alcohol was superior to povidone-iodine in eradicating skin flora at the surgical skin site before genitourinary prosthetic implantation. There does not appear to be any increased risk of urethral or genital skin irritation with the use of chlorhexidine compared to povidone-iodine. Chlorhexidine-alcohol appears to be the optimal agent for skin preparation before genitourinary prosthetic procedures.
authors.affiliation: Department of Urology, University of Florida, Gainesville, Florida, USA.
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Yeung
authors.forename: Shaun
authors.initials: S
authors.lastname: Grewal
authors.forename: Arnold
authors.initials: A
authors.lastname: Bullock
authors.forename: H Henry
authors.initials: HH
authors.lastname: Lai
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
mesh_terms: D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D000431:Ethanol / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011300:Preoperative Care; D011446:Prospective Studies; D019919:Prosthesis Implantation; D012867:Skin / Q000382:microbiology*; D053825:Suburethral Slings; D016741:Urinary Sphincter, Artificial
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol; D011206:Povidone-Iodine; D002710:Chlorhexidine