Darouiche and colleagues tested whether chlorhexidine‑alcohol skin preparation prevents more surgical‑site infections than povidone‑iodine in adults having clean‑contaminated surgery.
Randomized trial at 6 hospitals, 849 adults analyzed by intention to treat after clean‑contaminated operations, 30‑day follow‑up.
Preoperative cleansing with chlorhexidine‑alcohol would protect against infection better than povidone‑iodine.
Methods
Design
Multicenter randomized controlled trial
Setting
6 hospitals
Patients
Adults having clean‑contaminated surgery
849 in intention‑to‑treat analysis
813 in per‑protocol analysis (completed 30‑day follow‑up)
Groups
Chlorhexidine‑alcohol scrub (n = 409)
Povidone‑iodine scrub and paint (n = 440)
Follow-up
30 days
Primary outcome
Surgical‑site infection of any type
Key Findings
Any surgical‑site infection occurred in 9.5% of the chlorhexidine‑alcohol arm vs 16.1% of the povidone‑iodine arm (relative risk 0.59, 95% CI 0.41 to 0.85, p = 0.004).
Incisional infections were less frequent with chlorhexidine‑alcohol, both superficial (4.2% vs 8.6%, p = 0.008) and deep (1% vs 3%, p = 0.05).
Organ‑space infection did not differ between the groups (4.4% vs 4.5%).
Infection was 12.5% vs 20.5% after abdominal and 1.8% vs 6.1% after nonabdominal operations, but the effect did not differ significantly by surgery type (interaction p = 0.41).
Adverse events were similar (55.7% vs 58.2%), and no operating‑room fire or chemical skin burn occurred in either group.
Results were similar in the per‑protocol analysis of 813 patients who completed 30‑day follow‑up.
Board pearl
The authors estimated that about 17 patients would need chlorhexidine‑alcohol instead of povidone‑iodine prep to prevent one surgical‑site infection.
Authors' conclusion
Preoperative cleansing of the patient's skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery.
Darouiche and colleagues tested whether chlorhexidine‑alcohol skin preparation prevents more surgical‑site infections than povidone‑iodine in adults having clean‑contaminated surgery.
Randomized trial at 6 hospitals, 849 adults analyzed by intention to treat after clean‑contaminated operations, 30‑day follow‑up.
Preoperative cleansing with chlorhexidine‑alcohol would protect against infection better than povidone‑iodine.
Methods
Design
Multicenter randomized controlled trial
Setting
6 hospitals
Patients
Adults having clean‑contaminated surgery
849 in intention‑to‑treat analysis
813 in per‑protocol analysis (completed 30‑day follow‑up)
Groups
Chlorhexidine‑alcohol scrub (n = 409)
Povidone‑iodine scrub and paint (n = 440)
Follow-up
30 days
Primary outcome
Surgical‑site infection of any type
Key Findings
Any surgical‑site infection occurred in 9.5% of the chlorhexidine‑alcohol arm vs 16.1% of the povidone‑iodine arm (relative risk 0.59, 95% CI 0.41 to 0.85, p = 0.004).
Incisional infections were less frequent with chlorhexidine‑alcohol, both superficial (4.2% vs 8.6%, p = 0.008) and deep (1% vs 3%, p = 0.05).
Organ‑space infection did not differ between the groups (4.4% vs 4.5%).
Infection was 12.5% vs 20.5% after abdominal and 1.8% vs 6.1% after nonabdominal operations, but the effect did not differ significantly by surgery type (interaction p = 0.41).
Adverse events were similar (55.7% vs 58.2%), and no operating‑room fire or chemical skin burn occurred in either group.
Results were similar in the per‑protocol analysis of 813 patients who completed 30‑day follow‑up.
Board pearl
The authors estimated that about 17 patients would need chlorhexidine‑alcohol instead of povidone‑iodine prep to prevent one surgical‑site infection.
Authors' conclusion
Preoperative cleansing of the patient's skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery.