SLR - September 2010 - Patricia Kim

Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis
 
Reference: Darouiche, R.O., Wall, Jr., M.J., Itani, K.M.F., Otterson, M.F., Webb, A.L., Carrick, M.M., Miller, H.J., Awad, S.S., Crosby, C.T., Mosier, M.C., AlSharif, A., Berger, D.H. (2010). Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. The New England Journal of Medicine 362 (1): 18-26. 

Scientific Literature Reviews

Reviewed by: Patricia Kim, DPM
Residency Program: Beth Israel Deaconess Medical Center

Podiatric Relevance:
Among the many possible complications experienced in post-operative patients, surgical site infection ranks high on the list.  Hospitals across the country utilize varying preoperative skin cleansing preparations to decrease chances of infection from pathogens found on the skin.  This study hypothesizes that chlorhexidene-alcohol is superior to povidone-iodine antisepsis for preoperative skin cleansing.

Methods:
This prospective, randomized clinical trial measured the rates of infection 30 days after a clean-contaminated surgery in 849 patients at 6 university-affiliated hospitals in the US.  409 were scrubbed with 2% chlorhexidine gluconate and 70% isopropyl alcohol, and 440 were preoperatively scrubbed and then painted with an aqueous solution of 10% podvidone-iodine.  Participants with a history of allergy to chlorhexidine, alcohol, or iodophors were excluded.  Evidence of infection at or near the site of operation as well as the perceived inability to follow the patient’s course 30 days after the surgery was also exclusion criteria.  Efficacy outcomes were measured using Fisher’s exact test and calculating the relative risk of infection and 95% confidence intervals. 

Results:
Participants in the chlorhexidine-alcohol group had a significantly lower postoperative skin infection rate (9.5%) than those in the povidone-iodine group (16.1%; p=0.004).  The relative risk of surgical-site infection in patients scrubbed with chlorhexidine-alcohol versus povidone-iodine was 0.59 (95% confidence interval, 0.41 to 0.85); fewer superficial incisional infections (relative risk 0.48; 95% CI, 0.28 to 0.84) as well as fewer deep incisional infections (relative risk 0.33; 95% CI, 0.11 to 1.01) were also associated with chlorhexidine-alcohol. 

Conclusions:
The study found that patients preoperatively prepped with chlorhexidine-alcohol versus povidone-iodine had a significantly lower rate of surgical-site infection (9.5% vs. 16.1%; p=0.004) after clean-contaminated surgery.  It was also observed that chlorhexidine-alcohol was more protective against both superficial incisional infections and deep incisional infections than povidone-iodine. 

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