Chlorhexidine-alcohol vs povidone-iodine

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

Darouiche RO, Wall MJ, Itani KM, et al. The New England journal of medicine 2010 · PMID 20054046 · doi:10.1056/nejmoa0810988

Question

Is chlorhexidine-alcohol better than povidone-iodine for preoperative skin preparation in preventing surgical site infection?

Design

Multicentre randomised controlled trial in six US hospitals.

Patients

Adults having clean-contaminated surgery (mainly abdominal, also thoracic, gynaecological and urological).

Intervention

2% chlorhexidine gluconate with 70% isopropyl alcohol skin scrub

Comparison

Povidone-iodine scrub and paint

Primary outcome

Any surgical site infection within 30 days

Key result

Overall surgical site infection was significantly lower with chlorhexidine-alcohol (about 10% vs 16%), driven by fewer superficial and deep incisional infections; organ-space infection did not differ.

Limitations

It studied clean-contaminated rather than clean orthopaedic surgery, and the comparator was aqueous povidone-iodine, so the effect of alcohol and antiseptic agent cannot be separated.

Impact on practice

It is the key trial behind NICE's preference for alcohol-based chlorhexidine skin preparation, now standard in UK orthopaedic theatres. Allow alcoholic preparations to dry fully before diathermy because of the fire risk.