Chlorhexidine-alcohol superior to povidone-iodine for surgical prep

January 01, 0001

Chlorhexidine-alcohol superior to povidone-iodine for surgical prep

These US investigators randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections.

They found: “A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1, relative risk, 0.59). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6) and deep incisional infections (1% vs. 3%) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups.”

The authors concluded: ”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.”

Use of chlorhexidine-alcohol surgical site preparation should become standard procedure.

For the full abstract, click here.

N Engl J Med 362(1):18-26, 7 January 2010. © 2010 To the Massachusetts Medical Society.
Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. Rabih O. Darouiche, Matthew J. Wall, Kamal M.F. Itani, et al. Correspondence to Dr. Darouiche: [email protected]

Category A. General/Unspecified. Keywords: surgery, post-operative infection, chlorhexidine-alcohol, povidone-iodine, randomized controlled trial
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 27 January 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.