This RCT compared chlorhexidine-alcohol scrub to povidone-iodine scrub-and-paint for preoperative skin antisepsis in 849 adults undergoing clean-contaminated surgery. It was the first randomized trial to directly test whether the choice of skin prep agent affects surgical-site infection rates.
When you open a skin prep kit in the OR, this is the paper that determines what should be inside it. Before this trial, no randomized data existed comparing preoperative antiseptic agents — povidone-iodine was standard practice by convention, not evidence.
The clinical rule is straightforward: use chlorhexidine-alcohol for every elective case where it is not contraindicated. The 41% relative reduction in SSI and an NNT of 17 make this one of the highest-yield, lowest-cost changes in surgical prep.
The benefit is mechanistically confined to skin-derived infections — chlorhexidine-alcohol will not reduce intra-abdominal or organ-space infections, so do not expect it to change outcomes driven by enteric contamination.
For orthopedics specifically, prior work in foot-and-ankle surgery (Bibbo 2005, Ostrander 2005, both cited here) had already shown superior bacterial reduction with chlorhexidine — this RCT provided the clinical infection endpoint data that converted that microbiologic finding into practice-changing evidence.
This RCT compared chlorhexidine-alcohol scrub to povidone-iodine scrub-and-paint for preoperative skin antisepsis in 849 adults undergoing clean-contaminated surgery. It was the first randomized trial to directly test whether the choice of skin prep agent affects surgical-site infection rates.
When you open a skin prep kit in the OR, this is the paper that determines what should be inside it. Before this trial, no randomized data existed comparing preoperative antiseptic agents — povidone-iodine was standard practice by convention, not evidence.
The clinical rule is straightforward: use chlorhexidine-alcohol for every elective case where it is not contraindicated. The 41% relative reduction in SSI and an NNT of 17 make this one of the highest-yield, lowest-cost changes in surgical prep.
The benefit is mechanistically confined to skin-derived infections — chlorhexidine-alcohol will not reduce intra-abdominal or organ-space infections, so do not expect it to change outcomes driven by enteric contamination.
For orthopedics specifically, prior work in foot-and-ankle surgery (Bibbo 2005, Ostrander 2005, both cited here) had already shown superior bacterial reduction with chlorhexidine — this RCT provided the clinical infection endpoint data that converted that microbiologic finding into practice-changing evidence.