title: Observational study on preoperative surgical field disinfection: povidone-iodine and chlorhexidine-alcohol.
abstract: OBJECTIVE
  Surgical site infection (SSI) rate is reported to range around 16%. Preoperative skin disinfection is keystone for SSI reduction. Chlorhexidine-alcohol has been reported to be more effective than Povidone-iodine (PVI). However, in many countries established habits and the inferior costs of PVI restrain the employment of chlorhexidine disinfection kits (ChloraPrep®) for the preparation of the surgical field.
  
  
  METHODS
  The costs of surgical field preparation in clean-contaminated surgery utilizing PVI (Betadine) and chlorhexidine alcohol and the evaluation of surgeon compliance and satisfaction, were studied by a observational study on 50 surgical operations in which surgical field was prepared with PVI checking established guidelines, and on 50 surgical operations in which chlorhexidine-alcohol (ChloraPrep) was employed. The use of auxiliary material was tabulated as well as the timing of the phases of disinfection and the surgeon's opinions.
  
  
  RESULTS
  The use of auxiliary material (gloves, gauzes, paper towels, surgical instruments, small swabs for umbilical cleaning) is associated with the type of disinfectant, with major use of auxiliary materials recorded in PVI disinfection. PVI disinfection does not follow stringent guidelines, in particular waiting for the disinfectant to dry. PVI guidelines are more demanding than those relative to ChloraPrep. The time necessary for the preparation of the field is significantly longer for PVI. Auxiliary material and guideline compliance must be taken into account when calculating costs; the former are direct costs (even though marginal) and the latter can determine major infective risk.
  
  
  CONCLUSIONS
  Chlorhexidine in kits is easier and faster to use than PVI, requires less auxiliary material and has been shown previously to reduce SSI in clean contaminated surgery.
authors.affiliation: Acute Care and Trauma Surgery, Department of Surgery, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy. Sabina.magalini@rm.unicatt.it.
authors.forename: S
authors.initials: S
authors.lastname: Magalini
authors.forename: G
authors.initials: G
authors.lastname: Pepe
authors.forename: S
authors.initials: S
authors.lastname: Panunzi
authors.forename: A
authors.initials: A
authors.lastname: De Gaetano
authors.forename: C
authors.initials: C
authors.lastname: Abatini
authors.forename: A
authors.initials: A
authors.lastname: Di Giorgio
authors.forename: M
authors.initials: M
authors.lastname: Foco
authors.forename: D
authors.initials: D
authors.lastname: Gui
mesh_terms: D019840:2-Propanol / Q000008:administration & dosage* / Q000191:economics; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000191:economics; D016009:Chi-Square Distribution; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D003362:Cost-Benefit Analysis; D004203:Disinfection / Q000191:economics / Q000379:methods* / Q000592:standards; D017721:Hospital Costs; D006801:Humans; D011206:Povidone-Iodine / Q000008:administration & dosage* / Q000191:economics; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D013530:Surgical Wound Infection / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine