A prospective comparative study of chlorhexidine-alchohol versus povidone-iodine for surgical site antisepsis in clean contaminated surgery

Abstract

Background: Experience with surgical site infection after any surgical procedure is vast and spans generations of surgeons. Worldwide, surgeons use chlorhexidine-alchohol or povidone iodine as pre-operative skin cleansing agent. But it is still unknown that which one is better as there is no recommendation till date and is a topic of major debate among surgeons. Methods: A hospital based Prospective Comparative Study was undertaken among pre-operative skin swab culture positive patients who have undergone clean-contaminated surgery in a tertiary care hospital of Kolkata to compare between efficacy of Cholorhexidine-Alcohol and Povidone- Iodine as skin cleansing agent for prevention of surgical site infection. All the patients were followed-up for 30 days post-operatively for any evidence of wound infection. If the post-operative wound infection was due to same organism that was present in pre-operative skin swab culture report, then failure of skin cleansing agent was considered. Any specific sensitivity/resistance of any organism to specific skin cleansing agent were also noted. Results: Among the 90 patients under the study pre-operative antisepsis was found to be successful for 67(74.4%) patients. Cure rate for povidone iodine group (69.4%) was less than Cholorhexidine-alcohol group (80.5%). So, Cholorhexidine-alcohol found to have more strong pre-operative antiseptic action in the study but this difference was not statistically significant (p value0.229). Regarding specific organism sensitivity, both the agents were also comparable. Conclusion: Pre-operative skin cleansing plays a vital role in determining the surgical outcome. There is a need to conduct more in depth analytical studies for evaluation of specific sensitivity/resistance of micro- organisms against specific skin cleansing agent for appropriate selection of pre-operative skin cleansing agent to prevent post-operative surgical wound infection.