title: Randomized clinical trial of preoperative skin antisepsis with chlorhexidine gluconate or povidone-iodine.
abstract: BACKGROUND
  Skin antiseptic agents are used to prevent surgical-site infection (SSI); few trials have reported the superiority of any specific agent in clean-contaminated abdominal surgery. This RCT was designed to compare the effectiveness of chlorhexidine gluconate and povidone-iodine.
  
  
  METHODS
  Consecutive patients who underwent clean-contaminated upper gastrointestinal or hepatobiliary-pancreatic open surgery between 2011 and 2014 were assigned randomly to either chlorhexidine gluconate or povidone-iodine. The primary endpoint was the occurrence of SSI within 30 days of surgery. Secondary endpoints included causative organisms and risk factors for SSI.
  
  
  RESULTS
  A total of 534 patients were randomized; 31 (5·8 per cent) developed an SSI. There was no difference in the overall SSI rate in the chlorhexidine gluconate and povidone-iodine groups: 15 of 267 (5·6 per cent) and 16 of 267 (6·0 per cent) respectively (P = 0·853). The most common causative organism was Enterococcus faecalis. In subgroup analysis, biliary-pancreatic surgery had a higher SSI rate (26 of 127, 20·5 per cent) than upper gastrointestinal (2 of 204, 1·0 per cent) and hepatic (3 of 203, 1·5 per cent) resection. Both age (60 years and over) and type of incision were associated with the risk of SSI.
  
  
  CONCLUSIONS
  No difference was detected between chlorhexidine gluconate and povidone-iodine antiseptics for prevention of SSI. Registration number: NCT01495117 (http://www.clinicaltrials.gov).
authors.affiliation: Centre for Liver Cancer, National Cancer Centre, South Korea.
authors.forename: H M
authors.initials: HM
authors.lastname: Park
authors.affiliation: Centre for Liver Cancer, National Cancer Centre, South Korea.
authors.forename: S-S
authors.initials: SS
authors.lastname: Han
authors.affiliation: Centre for Liver Cancer, National Cancer Centre, South Korea.
authors.forename: E C
authors.initials: EC
authors.lastname: Lee
authors.affiliation: Centre for Liver Cancer, National Cancer Centre, South Korea.
authors.forename: S D
authors.initials: SD
authors.lastname: Lee
authors.affiliation: Centre for Gastric Cancer, National Cancer Centre, South Korea.
authors.forename: H M
authors.initials: HM
authors.lastname: Yoon
authors.affiliation: Centre for Gastric Cancer, National Cancer Centre, South Korea.
authors.forename: B W
authors.initials: BW
authors.lastname: Eom
authors.affiliation: Centre for Liver Cancer, National Cancer Centre, South Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Centre for Gastric Cancer, National Cancer Centre, South Korea.
authors.forename: K W
authors.initials: KW
authors.lastname: Ryu
authors.affiliation: Centre for Liver Cancer, National Cancer Centre, South Korea.
authors.forename: S-J
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Centre for Gastric Cancer, National Cancer Centre, South Korea.
authors.forename: Y W
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Biometric Research Branch, Research Institute and Hospital, National Cancer Centre, South Korea.
authors.forename: B
authors.initials: B
authors.lastname: Park
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011300:Preoperative Care; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D017592:Skin Care; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D002710:Chlorhexidine