Optimizing preoperative skin antisepsis has the potential to decrease surgical-site infections (SSI) given that the skin is a major source of pathogens. Unfortunately, there is a paucity of evidence to guide the choice of antiseptic at cesarean - the most common major surgical procedure in women in the United States. We tested the hypothesis that preoperative skin antisepsis with chlorhexidine-alcohol is superior to iodine-alcohol for preventing SSI after cesarean.
This was a randomized controlled trial. Pregnant women undergoing cesarean were randomly assigned to preoperative skin preparation with either chlorhexidine-alcohol or iodine-alcohol. The primary outcome was SSI within 30 days after cesarean based on the Centers for Disease Control Nosocomial Infections Surveillance System definitions. Secondary outcomes were individual subtypes of SSI, other wound complications and adverse skin reactions. Analysis was by intention-to-treat. We estimated a priori that 1084 subjects would afford 80% power to detect a 50% difference in SSI (baseline rate 8%, 2-tailed, α=0.05).
1082 subjects (538 in the chlorhexidine-alcohol group and 544 in the iodine-alcohol group) were included in the intention-to-treat analysis. The primary outcome, overall rate of SSI, was significantly lower in the chlorhexidine-alcohol group than in the iodine-alcohol group (4.3% vs. 7.7%; P=0.017; relative risk [RR], 0.55; 95% confidence interval [CI], 0.34 to 0.91) (Table/Figure). Chlorhexidine-alcohol was more protective than iodine-alcohol against superficial (3.2% vs. 5.2%) and deep (1.1% vs. 2.6%) infections, although the within-subtype differences were not statistically significant. Other wound complications and adverse skin reactions were similar in the two groups. Similar findings were observed in the as-treated analysis of 1068 subjects (4.1% vs. 7.6%; P=0.015; RR, 0.54; 95% CI, 0.33 to 0.90).
Preoperative skin antisepsis with chlorhexidine-alcohol is superior to iodine-alcohol for preventing SSI after cesarean.
© 2016 Published by Elsevier Inc.