Study To Reduce Infection Prior to Elective Cesarean Deliveries (STRIPES): a randomized clinical trial of chlorhexidine

Abstract

BACKGROUND: Surgical site infections after cesarean delivery are a cause of maternal morbidity and are typically caused by skin microbial flora. Preadmission application of chlorhexidine gluconate using impregnated cloths may decrease surgical site infections by decreasing the abundance of microbial flora. OBJECTIVE: To determine whether the application of chlorhexidine gluconate cloths the night before and the morning of scheduled cesarean delivery decreases the risk of surgical site infections by 6 weeks postoperatively compared with placebo. STUDY DESIGN: In this single-center, double-blind, placebocontrolled trial, patients were randomized (1:1) to receive either Sage 2% chlorhexidine cloths or Sage Comfort Bath fragrance-free cloths (placebo) to apply to 6 skin sites on the body (neck, shoulders and chest, armpits, arm and hands, abdomen and groin, left leg and foot, right leg and foot, back and buttocks) the night before and after a shower the morning of scheduled cesarean delivery. Routine clinical and operative procedures were followed. The primary outcome was surgical site infections (superficial or deep incisional with or without organ space endometritis) by 6 weeks after cesarean delivery. The secondary outcomes were surgical site infections by 2 weeks and other wound-related complications by 2 and 6 weeks after cesarean delivery.

Continuous versus disrupted subcutaneous tissue closure in cesarean section: A retrospective cohort study

“…The overall incidence of postpartum surgical-site complications has been reported as 1%-18%. 5,6,19 These complications disrupt recovery, increase the use of antibiotics and analgesics, and prolong hospitalization. 20 In particular, women with postoperative SSI are less likely to breastfeed and more likely to experience postpartum depression, thus negatively affecting both mothers and their neonates.…”

“…The overall incidence of postpartum surgical‐site complications has been reported as 1%–18% 5,6,19 . These complications disrupt recovery, increase the use of antibiotics and analgesics, and prolong hospitalization 20 .…”

Exploring the Limits of Artificial Intelligence for Referencing Scientific Articles

“…July 2020 Study to reduce infection prior to elective cesarean deliveries (STRIPES): a randomized clinical trial of chlorhexidine27 AJOGJuly 2020 Perioperative prophylactic internal iliac artery balloon occlusion in the prevention of postpartum hemorrhage in placenta previa: a randomized controlled trial28 AJOGAugust 2020 Evaluation of an external fetal electrocardiogram monitoring system: a randomized controlled trial29 AJOGSeptember 2020Prelabor screening at term using the cerebroplacental ratio and placental growth factor: a pragmatic randomized open-label phase 2 trial30 AJOGNovember 2020 Prospective, randomized, double-blind, placebo-controlled evaluation of the pharmacokinetics, safety and efficacy of recombinant antithrombin versus placebo in preterm preeclampsia31 AJOG December 2020 Physical examination-indicated cerclage in twin pregnancy: a randomized controlled trial32 UOG January 2020 Elective delivery at 34 weeks vs routine obstetric care in fetal gastroschisis: randomized controlled trial33 UOGApril 2020Multicenter randomized trial exploring effects of simulation-based ultrasound training on obstetricians' diagnostic accuracy: value for experienced operators34 OG February 2020 Ropivacaine and ketorolac wound infusion for post-cesarean delivery analgesia: a randomized controlled trial35 OG April 2020 Cephalic elevation device for second-stage cesarean delivery: a randomized controlled trial36 …”

Preoperative Application of Chlorhexidine to Reduce Infection with Cesarean Delivery after Labor (PRACTICAL): A Randomized Clinical Trial

“…2,3 The most common complication of CD is increased risk of infectious morbidity, occurring in 5 to 10% of cesarean deliveries, a fivefold higher rate than vaginal deliveries. 4 Postinfectious morbidity includes risks of increased length of stay, readmission, significant and limiting pain or discomfort, 5,6 financial burden, and depression. 7 While preoperative antibiotic use and abdominal preparation with antiseptic solution are standard of care for infection prophylaxis, rates of infectious morbidity remain significant, indicating a need to further mitigate this risk.…”

“…Prior randomized trials have demonstrated superiority of CHG compared with povidone-iodine abdominal preparation for the prevention of SSIs. [13][14][15] While patient-applied preadmission chlorhexidine cloths have decreased SSIs in the orthopaedic literature, 16 in nonlabor CD, preadmission use of CHG cloths did not reduce the risk of infection 6 ; however, these have not been investigated in CD after labor. CHG is preferred for vaginal surgical site antisepsis in other countries, 17,18 but povidone-iodine is most commonly used in the United States.…”