Chlorhexidine -alcohol versus povidone -iodine + Alcohol as pre-operative antiseptic for Prevention of surgical site infection in cesarean Section : a randomised control trial

Abstract

Introduction : Caesarean Section (CS) is the most common procedure performed and its rate is on the rise. Surgical site infection (SSI) is a dreaded post-operative complication. The most commonest disinfectants studied are PI and chlorhexidine alcohol(3).So we want to know the efficacy of chlorhexidine- based antiseptic protocol versus PI protocol as a pre-operative skin preparation in reducing SSI for patients undergoing CS Aim and objectives of the study : Primary objective was to establish the efficacy of chlorhexidine-based antiseptic protocol versus povidone-iodine protocol in reducing SSI for patients undergoing caesarean deliveries. and the organism growth on swabs taken Materials and 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 notes. The study lasted for 18months with 208 participants. The surgical sites will be inspected on post-op day 2 and cleaned with surgical spirit and will be covered with sterile dressing sterizone (transparent filament with a silver lining in the center). The wound was inspected on day 5/day 7, or at the time of discharge, whichever was later. In case of wound discharge, the wound swabs were taken and sent for culture and sensitivity. Statistical analysis was performed using JMP-SAS Software, with results presented as mean ± S.D., counts and percentages, and diagrams. Comparisons were made using independent t-tests, Mann-Whitney U tests, Chi- square test/Fisher's Exact tests. Results : A total of 208 subjects (104 in the chlorhexidine group and 104 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 (2.90% vs. 11.50%; P=0.02). Chlorhexidine–alcohol was significantly more protective than PI against both superficial infections (1.00% vs. 8.70%,P=0.018) and deep infections (1.90% vs. 2.90%,P=0.018). There was no significant differences in the frequency of isolating organisms. Staphylococcus aureus was the commonest bacteria isolated. Conclusion - This study highlighted that Chlorhexidine-alcohol providedsuperior skin antisepsis in comparison to PI.