title: A retrospective analysis of surgical site infections after chlorhexidine-alcohol versus iodine-alcohol for pre-operative antisepsis.
abstract: BACKGROUND
  Surgical site infection (SSI) is the most common hospital-acquired infection in the Netherlands. There is little evidence in regard to differences in the efficacy of pre-operative topical antisepsis with iodine-alcohol as compared with chlorhexidine-alcohol for preventing SSI.
  
  
  METHODS
  We conducted a retrospective analysis at a single center, involving all patients who underwent breast, colon, or vascular surgery in 2010 and 2011, in which pre-operative disinfection of the skin was done with iodine-alcohol in 2010 and with chlorhexidine-alcohol in 2011. Demographic characteristics, surgical parameters, and rates of SSI were compared in the two groups of patients. Subgroup analyses were done for wound classification, wound type, and type of surgery performed. Associations of patient characteristics with SSI were also investigated. Data were analyzed with χ(2) tests, Student t-tests, and logistic regression analysis.
  
  
  RESULTS
  No statistically significant difference was found in the rates of SSI in the two study groups, at 6.1% for the patients who underwent antisepsis with iodine-alcohol and 3.8% for those who underwent disinfection with chlorhexidine-alcohol (p=0.20). After multivariable analysis, an odds ratio (OR) of 0.68 (95% confidence interval [CI] 0.30-1.47) in favor of chlorhexidine-alcohol was found. Male gender, acute surgery, absence of antibiotic prophylaxis, and longer hospital length of stay (LOS) were all associated with SSI after pre-operative topical antisepsis.
  
  
  CONCLUSIONS
  In this single-center study conducted over a course of one year with each of the preparations investigated, no difference in the rate of SSI was found after an instantaneous protocol change from iodine-alcohol to chlorhexidine-alcohol for pre-operative topical antisepsis.
authors.affiliation: Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands .
authors.forename: Ayoub
authors.initials: A
authors.lastname: Charehbili
authors.forename: Rutger-Jan
authors.initials: RJ
authors.lastname: Swijnenburg
authors.forename: Cornelis
authors.initials: C
authors.lastname: van de Velde
authors.forename: Jephta
authors.initials: J
authors.lastname: van den Bremer
authors.forename: Willem
authors.initials: W
authors.lastname: van Gijn
mesh_terms: D000328:Adult; D000368:Aged; D000438:Alcohols / Q000627:therapeutic use; D000985:Antisepsis / Q000379:methods*; D002710:Chlorhexidine / Q000627:therapeutic use*; D004202:Disinfectants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007455:Iodine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000438:Alcohols; D004202:Disinfectants; D007455:Iodine; D002710:Chlorhexidine