Chlorhexidine and Alcohol Versus Povidone-Iodine for Antisepsis in Gynecological Surgery

Abstract

This retrospective study demonstrates that antisepsis with chlorhexidine and alcohol was associated with a significant reduction in the rate of SSIs compared to povidone-iodine antisepsis in patients undergoing elective gynecological laparotomies. This is of extreme clinical importance, as a change in antisepsis protocol can significantly reduce the morbidity and healthcare costs associated with patients undergoing elective gynecological surgery.

Single-Field Sterile Scrub, Preparation, and Dwell for Laparoscopic Hysterectomy

“…Chlorhexidine cleansing of the vagina seems to be safe [14], with less than 1% allergic reaction [15]. In a retrospective review of 256 patients undergoing gynecologic surgery, Levin et al [16] reported that chlorhexidine 2% seemed to reduce the rate of SSIs, from 15% to 5%, compared with povidone-iodine 10% scrub and paint. However, each of these preparations also contained 65% to 70% alcohol, and the method of vaginal preparation was not specified in that report.…”

“…It is possible that the friction from the required vaginal scrubbing with antimicrobial agents during the cleansing process is more important in removing bacterial organisms than the specific agent used [12,17]. Culligan et al [14] also used such cleansing process with each of the antibacterial agents, using a ''vigorous 2 minute scrub in and around the vagina using disposable sponges,'' followed by a ''paint,'' and application of either povidone-iodine or chlorhexidine, depending on which bactericide the patient was randomized to receive; however, neither Dariouche et al [15] nor Levin et al [16] reported their technique for sterile preparation of the vagina.…”

New Strategies for Preoperative Skin Antisepsis

“…The efficacy of skin antisepsis in the prevention of SSI has been determined in clinical studies that examined SSI rates after administering different skin antiseptic formulations [6,7,8,9]. However, most of the studies considered were difficult to compare as they followed different protocols, were conducted in different settings and used a range of different antiseptics with different formulations.…”

Preoperative Skin Antiseptic Preparations for Preventing Surgical Site Infections: A Systematic Review

“…25 Twelve studies defined SSI according to CDC criteria. 10,13,14,[21][22][23][24][25][26][27][28][29] The remainder were based on predefined microbiological or clinical criteria. One study 20 reported bacterial colony counts as the primary measure of antiseptic effectiveness and did not report SSIs.…”

“…Patients lost to follow-up were described in 3 studies. 13,22,24 Four studies 10,11,15,25 reported poor compliance with the assigned intervention. Two of these 10,15 used patients who failed to comply with antisepsis instructions as controls.…”