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Chlorhexidine gluconate vaginal preparation to prevent gynecologic surgical site infections: a quality improvement project

      Objectives

      Chlorhexidine gluconate has been shown to be superior to povidone iodine at decreasing bacterial colony counts. It has also been shown to be superior to povidone iodine at decreasing postpartum endometritis after cesarean delivery. Additionally, multiple studies have shown that 4% chlorhexidine gluconate is safe for use in the vagina despite the manufacturer’s label stating it is not for use in genital area. The objective of this project is to decrease surgical site infections after gynecologic surgery at a single institution by implementing a standard vaginal preparation with 4% chlorhexidine gluconate preparation.

      Materials and Methods

      Data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was used to assess the rate of surgical site infections and surgical readmissions at our institution prior to and after the implementation of a standardized vaginal preparation with chlorhexidine gluconate. At our institution, there was not a standard vaginal preparation used, although povidone iodine was used most commonly. Chlorhexidine gluconate was established as the standard vaginal preparation at our institution in July 2019.

      Results

      After implementation, our NSQIP surgical site infection occurrence decreased to 1.1% in 2019 and 2.2% in 2020. Additionally, readmission after gynecologic surgery decreased over this time frame. Prior to this, our 2018 NSQIP data showed a surgical site infection occurrence of 3.4% which was higher than the national average.

      Conclusion

      In conclusion, implementing a standard vaginal preparation for gynecologic surgery with 4% chlorhexidine gluconate decreased the rate of surgical site infections and readmissions after gynecologic surgery at our institution.