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

• Published in: The New England journal of medicine Vol. 362; no. 1; pp. 18 - 26
• Main Authors: Darouiche, Rabih O, Wall, Matthew J, Itani, Kamal M.F, Otterson, Mary F, Webb, Alexandra L, Carrick, Matthew M, Miller, Harold J, Awad, Samir S, Crosby, Cynthia T, Mosier, Michael C, AlSharif, Atef, Berger, David H
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 07.01.2010
• Subjects: 2-Propanol - adverse effects; 2-Propanol - therapeutic use; Adult; Alcohol; Analysis of Variance; Anti-Infective Agents, Local - adverse effects; Anti-Infective Agents, Local - therapeutic use; Antisepsis - methods; Aqueous solutions; Biological and medical sciences; Chlorhexidine; Chlorhexidine - adverse effects; Chlorhexidine - analogs & derivatives; Chlorhexidine - therapeutic use; Cross Infection - prevention & control; Drug Combinations; Family medical history; Female; General aspects; Grants; Hospitalization; Hospitals; Humans; Infections; Iodine; Kaplan-Meier Estimate; Logistic Models; Male; Medical sciences; Middle Aged; Motivation; Patients; Polymerase Chain Reaction; Povidone; Povidone-Iodine - adverse effects; Povidone-Iodine - therapeutic use; Prevention; Risk Factors; Scrub; Skin; Skin - microbiology; Surgeons; Surgery; Surgical site infections; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; Surgical Wound Infection - prevention & control; United States > US; Surgical wound; Antisepsis; Ethanol; Povidone iodine; Alcohol; Guanidines; Medicine; Alcoholic beverage; Biguanides; Antiseptic; Chlorhexidine; Disinfecting agent; Comparative study
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa0810988

The skin is a source of infection associated with surgery. In this multicenter, randomized trial, the preoperative application of chlorhexidine–alcohol was found to be a more effective skin preparation than povidone–iodine for preventing incisional infections. The preoperative application of chlorhexidine–alcohol was found to be a more effective skin preparation than povidone–iodine for preventing incisional infections. Despite the implementation of preoperative preventive measures, which include skin cleansing with povidone–iodine, surgical-site infection occurs in 300,000 to 500,000 patients who undergo surgery in the United States each year. 1 – 6 Since the patient's skin is a major source of pathogens, it is conceivable that improving skin antisepsis would decrease surgical-site infections. 7 The Centers for Disease Control and Prevention (CDC) recommends that 2% chlorhexidine-based preparations be used to cleanse the site of insertion of vascular catheters. 8 However, the CDC has not issued a recommendation as to which antiseptics should be used preoperatively to prevent postoperative surgical-site infection in the 27 . . .