Chlorhexidine and alcohol versus povidone-iodine for antisepsis in gynecological surgery

Background: Surgical site infections (SSIs) cause severe morbidity and are associated with tremendous health costs. Skin antisepsis (cleansing) with chlorhexidine and alcohol solutions has demonstrated superiority to povidone-iodine in a variety of surgical interventions. Our objective was to determine if chlorhexidine and alcohol antisepsis protocol reduces the rate of SSIs in elective gynecological laparotomies compared with povidone-iodine antisepsis. Methods: This retrospective study was carried out at the Department of Gynecology in a tertiary medical center in Tel Aviv. Patients undergoing elective gynecological laparotomies during two periods of time and who were treated with two different antisepsis protocols were included. The protocols for antisepsis were povidone-iodine 10% scrub followed by 10% povidone-iodine in 65% alcohol (n=145) and chlorhexidine 2% followed by 70% alcohol (n=111). The rate of SSIs as defined by the Centers for Disease Control and Prevention (CDC), and the risk factors for the occurrence of SSIs were calculated. Results: Antisepsis with chlorhexidine and alcohol was associated with a reduction in the overall rate of SSIs from 14.6% to 4.5% compared with the povidone-iodine protocol (p=0.011). The two groups of patients were similar in regard to baseline characteristics and medical history. Surgical procedures as well as the type of cut, drains, and tension suture use were similar in the two groups. Patients with SSIs tended to be older and heavier. Risk factors found to be associated with SSIs were hypertension, noninsulin-dependent diabetes mellitus (NIDDM), immunodeficiency, and the use of the povidone-iodine antisepsis protocol. Conclusions: 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.