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

Research output: Contribution to journalArticlepeer-review

848 Scopus citations

Abstract

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.).

Original languageEnglish (US)
Pages (from-to)18-26
Number of pages9
JournalNew England Journal of Medicine
Volume362
Issue number1
DOIs
StatePublished - Jan 7 2010

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis'. Together they form a unique fingerprint.

Cite this