scholarly journals Chlorhexidine–alcohol versus povidone–iodine as preoperative skin antisepsis for prevention of surgical site infection in cesarean delivery—a pilot randomized control trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Athokpam Lenin Luwang ◽  
Pradip Kumar Saha ◽  
Minakshi Rohilla ◽  
Pooja Sikka ◽  
Lekha Saha ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Povidone Iodine ◽  
Statistical Significance ◽  
Site Infection ◽  
Skin Preparation ◽  
Alcohol Group ◽  
E Coli ◽  
Skin Antisepsis ◽  
Clinical Trials Registry

Abstract Objectives To compare the efficacy of chlorhexidine–alcohol and povidone–iodine as preoperative antiseptic skin preparation for prevention of surgical site infection (SSI) after cesarean delivery (CD). Materials and methods A total of 311 eligible women who underwent CS were recruited in the study after fulfilling all the eligibility and exclusion criteria. Patients were randomized into two groups (153 in chlorhexidine–alcohol group and 158 in povidone–iodine group) by a computer-generated randomization table. Patients were followed for a period of 30 days in postoperative period to monitor for SSI. Results The rate of SSI in the chlorhexidine–alcohol group is 5.4% and that of the povidone–iodine group is 8.6%. E. coli, K. pneumoniae, and Acinetobacter baumannii were the most common organisms isolated. E. coli was found in 9.5% of the total SSI cases. Conclusions The study found that the patients who received chlorhexidine–alcohol as skin antiseptic had less chance of developing SSI than those who received povidone–iodine; however, it did not reach a statistical significance. Trial registration Clinical Trials Registry of India CTRI/2018/05/014294. Registered on May 31, 2018

Chlorhexidine-alcohol versus povidone-iodine as preoperative skin antisepsis for prevention of Surgical Site Infection in Cesarean Section

2021 ◽  
Author(s):  
Athokpam Lenin Luwang ◽  
Pradip Kumar Saha ◽  
Minakshi Rohilla ◽  
Pooja Sikka ◽  
lekha saha ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Statistical Significance ◽  
Site Infection ◽  
Exclusion Criteria ◽  
Skin Preparation ◽  
Alcohol Group ◽  
Post Operative Period ◽  
Skin Antisepsis

Abstract Objectives: To compare the efficacy of chlorhexidine-alcohol and povidone-iodine as preoperative antiseptic skin preparation for prevention of Surgical site infection(SSI) after Cesarean Section(CS).Materials and Methods: A total of 311 eligible women who underwent CS were recruited in the study after fulfilling all the inclusion and exclusion criteria. Patients were randomized into two groups (153 in Chlorhexidine-alcohol Group and 158 in povidone-iodine Group) by computer-generated randomization table. Patients were followed for a period of 30 days in post operative period to monitor for SSI.Results: The overall rate of SSI was 7%, out of which chlorhexidine-alcohol group had 5.4% and povidone-iodine group had 8.6%. E.coli, K.pneumoniae and Acinetobacter baumannii were the most common organism isolated. E.coli was found in 9.5% of the total SSI cases.Conclusions: The study found that the patients who received chlorhexidine-alcohol as skin antiseptic had less chance of developing SSI than those who received povidone iodine however it did not reach statistical significance.

Chlorhexidine–Alcohol Compared with Povidone–Iodine Preoperative Skin Antisepsis for Cesarean Delivery: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 36 (02) ◽  
pp. 118-123 ◽  
Author(s):  
Megan Whitham ◽  
Sherif El-Nashar ◽  
Steven Clark ◽  
Mary Tolcher
Keyword(s):  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Povidone Iodine ◽  
Meta Analysis ◽  
Site Infection ◽  
Superficial Infection ◽  
Skin Preparation ◽  
Statistical Heterogeneity ◽  
Significant Difference ◽  
Skin Antisepsis

Objective To compare chlorhexidine–alcohol with povidone–iodine solutions for skin antisepsis prior to cesarean delivery for the prevention of surgical site infection. Study Design Electronic databases MEDLINE, Embase, Scopus, and Clinicaltrials.gov were searched from inception to August 2017. Eligible studies included randomized controlled trials comparing chlorhexidine–alcohol with povidone–iodine skin preparation solutions for women undergoing cesarean delivery. The primary outcome was surgical site infection including superficial or deep wound infection. Meta-analysis was performed, and risk ratios (RRs) with 95% confidence interval (CI) were calculated using the Mantel–Haenszel random effects model. Statistical heterogeneity was assessed using Higgin's I 2. Results Of 61 abstracts identified in the primary search, four studies (3,059 women) met the eligibility criteria. The risk of surgical site infection was significantly reduced with chlorhexidine–alcohol (RR: 0.72; 95% CI: 0.52–0.98). No heterogeneity across studies was observed with I 2 = 0%. Subgroup analysis of superficial infection only or deep infection only showed no statistically significant difference (RR: 0.76, 95% CI: 0.54–1.08; and RR: 0.50, 95% CI: 0.23–1.10, respectively). Conclusion Preoperative skin cleansing prior to cesarean delivery with chlorhexidine–alcohol reduces surgical site infection as compared with povidone–iodine solutions.

scholarly journals Chlorhexidine-alcohol versus Povidone-Iodine-alcohol for surgical site antisepsis in caesarean section

2019 ◽  
Vol 8 (4) ◽  
pp. 1359
Author(s):  
Vishnu Priya Kesani ◽  
Sruthi Talasila ◽  
Sheela S. R.
Keyword(s):  
Caesarean Section ◽  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Care Center ◽  
Tertiary Care ◽  
Site Infection ◽  
Healthcare Associated Infection ◽  
Skin Antisepsis ◽  
Control And Prevention ◽  
Healthcare Associated

Background: Caesarean section is one of the most common procedures performed. Recent studies found that surgical-site infection (SSI) was the most common healthcare-associated infection. Authors hypothesized that optimization of preoperative skin antisepsis may decrease postoperative infections. The objective was to establish the efficacy of chlorhexidine-based antiseptic protocol versus povidone-iodine protocol in reducing SSI for patients undergoing caesarean deliveries.Methods: This is a randomized prospective study conducted from April 2017 to September 2017 at a tertiary care center in India. Women who underwent caesarean sections were allocated into either group. Enrolled patients were randomly assigned to have the surgical site painted with chlorhexidine-alcohol preparation or painted with a solution of 10% povidone-iodine and then with surgical spirit. The outcomes were any SSI occurring within a week or during the 30 day follow up period of the surgery including any of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions.Results: A total of 560 subjects (273 in the chlorhexidine group and 287 in the iodine group) qualified for the study. The number of surgical-site infection was significantly lower in the chlorhexidine group than in the iodine group (6.95% vs. 14.28%; P=0.005). Chlorhexidine–alcohol was significantly more protective than iodine-alcohol against both superficial incisional infections (5.49% vs. 10.10%, P=0.03) and deep incisional infections (1.46% vs. 4.18%, P=0.04).Conclusions: This study highlighted that Chlorhexidine-alcohol provided superior skin antisepsis in comparison to povidone iodine-alcohol.

scholarly journals Impact of choice of skin preparation solution in cardiac surgery on rate of surgical site infection: a propensity score matched analysis

2017 ◽  
Vol 19 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Shahzad G Raja ◽  
Melissa Rochon ◽  
Clair Mullins ◽  
Carlos Morais ◽  
Antonios Kourliouros ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Relative Risk ◽  
Propensity Score ◽  
Confidence Interval ◽  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Chlorhexidine Gluconate ◽  
Site Infection ◽  
Skin Preparation ◽  
Significant Superiority

Background: Antiseptic skin preparations containing chlorhexidine gluconate and povidone iodine are routinely used to reduce the risk of surgical site infection (SSI). This study assesses the efficacy of two alcohol-based solutions, 2% chlorhexidine-alcohol and 10% povidone iodine-alcohol, on the incidence of cardiac SSI. Methods: A total of 738 consecutive patients undergoing cardiac surgery had skin preparation with 2% chlorhexidine gluconate in 70% isopropanol (ChloraPrep, BD Ltd, UK) were propensity matched to 738 patients with skin prepared with 10% povidone–iodine in 30% industrial methylated spirit (Videne Alcoholic Tincture, Ecolab Ltd, UK). Continuous, prospective SSI surveillance data were collected for all these patients. A retrospective analysis of prospectively collected perioperative data was performed. Results: The overall rate of SSI was similar in the chlorhexidine–alcohol and povidone–iodine–alcohol groups (3.3% versus 3.8%; P = 0.14; relative risk [RR] = 0.98; 95% confidence interval [CI] = 0.52–1.78). Superficial (1.2% versus 1.8%; P = 0.18; RR = 0.97; 95% CI = 0.48–1.80) and deep incisional (1.2% versus 1.6%; P = 0.24) SSI rates were also similar with 10% povidone–iodine–alcohol being marginally more effective against organ-space infections (0.8% versus 0.4%; P = 0.05; RR = 0.38; 95% CI = 0.20–1.01). Conclusion: Our analysis confirms that alcohol-based skin preparation in cardiac surgery with povidone–iodine reduces the incidence of organ-space infections with no significant superiority in preventing incisional SSI compared with chlorhexidine-alcohol.

scholarly journals Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis

2017 ◽  
Vol 26 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Tasya Anggrahita ◽  
Aditya Wardhana ◽  
Gentur Sudjatmiko
Keyword(s):  
Surgical Site Infection ◽  
Risk Ratio ◽  
Povidone Iodine ◽  
Meta Analysis ◽  
Included Study ◽  
Site Infection ◽  
Skin Preparation ◽  
Positive Skin ◽  
Cost Rate ◽  
Pubmed Database

Background: Surgical site infection remains substantial problems to surgeons and patients as it increases the morbidity, mortality, length of stay, hospital cost, rate of re-admission, and rate of re-surgery. This study aims to compare the use of chlorhexidine-alcohol versus povidone-iodine for preoperative skin preparation to prevent surgical site infection.Methods: The literature search was conducted through the PubMed database on November 2015. Included studies were RCTs with the year of publication up to 2015 which compared the use of chlorhexidine-alcohol versus povidone-iodine in its effectiveness reducing surgical site infection in adult patients. The quality of the study was assessed using Jadad Score. A meta-analysis was conducted in the included study to obtain a pooled estimate of the effect size. The evidence of heterogeneity and publication bias was also assessed.Results: Six RCTs with a total of 2,080 patients were included in the meta-analysis. It showed that the use of chlorhexidine-alcohol was associated significantly with fewer SSIs (pooled risk ratio=0.60 (95% CI=0.45-0.79)) and fewer positive skin culture results (pooled risk ratio, RR=0.38 (95% CI=0.28-0.51)) compared with povidone iodine.Conclusion: Preoperative skin antisepsis with chlorhexidine is more effective than povidone-iodine in preventing surgical site infection.

scholarly journals Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery

2021 ◽  
Author(s):  
Rolando Figueroa Roberto ◽  
Flynn Andrew Rowan ◽  
Deepak Nallur ◽  
Blythe Durbin-Johnson ◽  
Yashar Javidan ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Povidone Iodine ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Site Infection ◽  
Infection Rates ◽  
Vancomycin Powder

Abstract Background Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. Methods We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model. Results 475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied. Conclusions A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures. Level of evidence Level II.

scholarly journals Does Skin Preparation Influence Surgical Site Infection in Laparotomy Wounds: Comparative Evaluation of Preoperative Skin Preparation With 4% Chlorhexidine With 5% Povidone Iodine in Laparotomy Wounds: A Prospective Trial

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Ravindran Chirukandath ◽  
Manoj P. Elangovan ◽  
Agil B. ◽  
Reshma A. Cheedhamadathil ◽  
Ayana M. Dev ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Prospective Trial ◽  
Surgical Site Infections ◽  
P Value ◽  
Site Infection ◽  
Related Complication ◽  
Skin Preparation ◽  
Emergency Procedures ◽  
Significant Difference

Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109,  5% Povidone iodine prepared patients undergoing various elective n = 114 and emergency procedures n = 123. The overall SSI rates in 7 days in the whole group were 13.44 %. The SSI rates on the 4% Chlorhexidine group were 10.16% and 5% povidone iodine group were 17.27% and it was statically significant with a p value of p = 0.00413 showing significant reduction in the 4% Chlorhexidine group. The study also compared the SSI rates in elective and emergency procedures in both groups with significant difference in emergency procedures. More variables are also compared between the groups and results were analyzed. Conclusion: This study shows the use of Chlorhexidine 4% reduces the morbidity of one of the most common wound related complication in laparotomy patients in all categories of laparotomy wounds.

scholarly journals Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates A Prospective Study of 3 Skin Preparation Protocols

2009 ◽  
Vol 30 (10) ◽  
pp. 964-971 ◽  
Author(s):  
Brian R. Swenson ◽  
Traci L. Hedrick ◽  
Rosemarie Metzger ◽  
Hugo Bonatti ◽  
Timothy L. Pruett ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
General Surgery ◽  
Isopropyl Alcohol ◽  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Skin Preparation ◽  
Improvement Project ◽  
Period 2

Objective.To compare the effects of different skin preparation solutions on surgical-site infection rates.Design.Three skin preparations were compared by means of a sequential implementation Design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% Chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner.Setting.Single large academic medical center.Patients.All adult general surgery patients.Results.The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% Chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001).Conclusions.Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to Chlorhexidine for this purpose in general surgery patients.

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