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JOURNAL ARTICLE
MULTICENTER STUDY
RANDOMIZED CONTROLLED TRIAL

Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis

Rabih O Darouiche, Matthew J Wall, Kamal M F Itani, Mary F Otterson, Alexandra L Webb, Matthew M Carrick, Harold J Miller, Samir S Awad, Cynthia T Crosby, Michael C Mosier, Atef Alsharif, David H Berger
New England Journal of Medicine 2010 January 7, 362 (1): 18-26
20054046

BACKGROUND: Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine.

METHODS: We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections.

RESULTS: A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups.

CONCLUSIONS: Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)

Comments

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Antonio Guimaraes wrote:

15

Always prefered chlorohexedine.

Tashique Alam wrote:

11

Finally a definitive result

SAFI UR REHMAN wrote:

7

We use both povidone iodine and alcohol,
Iodine first , let it dry and then use alcohol. May its worth another trial the effectiveness of combination with either povidone iodine or alcohol. Safi ur Rehman.

Imtiaz Ahmed wrote:

5

Contrary to common practice. Preop preparation needs change.

Muhammad Ibrahim wrote:

3

Using both is a better option specially those rare people having allergy to povidone iodine

Amik Munankarmy wrote:

0

Preoperatively we use iodine for painting and at the end of closure we dress with alcohol

Chuanxue Zhang wrote:

0

乙醇浓度是多少?有双重作用?

Glen Farrow wrote:

0

What about the risk of diathermy burns from ignition of pooled alcohol. This is an uncommon but well known risk with alcoholic skin prep. I think some still prefer aqueous for that reason

Fermin Lobo wrote:

0

En Honduras primero lavamos la piel con jabón de clorhexidina alcohol y luego aplicamos una pintura de yodopovidona. En otras palabras usamos los dos métodos.

Bijoy Abraham wrote:

0

Chlorhex alcohol dries much faster , especially if your using stick on drapes instead of cloth drapes.

Carmen Ruiz wrote:

0

How about alcoholic betadine?

Melvin Sánchez wrote:

0

Los odontólogos en Perú prefieren la Clorhexidina

Artevsovs Gambiza wrote:

-5

Alcoholic beta dine baths are very effective on the recovery of deep industrial burns and can expedite tissue replacement if applied daily under simultaneous cognitive pain management.

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