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Chlorhexidine before cesarean delivery reduces SSI risk
Preoperative skin antisepsis using chlorhexidine-alcohol as opposed to iodine-alcohol appeared to reduce infections among women undergoing cesarean delivery, according to study results published in The New England Journal of Medicine.
“One of the biggest complications of surgery, and of C-sections in particular, is infection,” Methodius G. Tuuli, MD, MPH, assistant professor of obstetrics and gynecology at Washington University School of Medicine, said in a press release. “For a new mother who needs to care for her baby — which is stressful even when all things are equal — having an infection can really impair her ability to do that. We are very interested in clarifying the best ways to prevent these infections, reducing the burden on patients, on their infants and on the health care system as a whole.”
In a randomized controlled trial, Tuuli and colleagues enrolled 1,147 pregnant women undergoing cesarean section at Washington University Medical Center from September 2011 to June 2015. Participants who did not have conflicting allergies or a skin infection adjacent to the operative site were randomly assigned to receive skin preparation with either a chlorhexidine-alcohol combination or an iodine-alcohol combination. Study staff monitored patients daily until discharge, and then 30 days after delivery to determine incidence of the study’s primary outcome, development of superficial or deep surgical-site infection (SSI). Secondary outcomes included the length of a patient’s hospital stay, physician visits and hospital readmissions for related complications, endometritis, positive wound culture, skin irritation, allergic reaction and other wound complications.
The researchers found a decreased rate of SSI among patients who received chlorhexidine-alcohol when compared with those who received iodine-alcohol (4% vs. 7.3%; RR = 0.55; 95% CI, 0.34-0.9). This outcome was maintained when analyzing within subgroups and was not influenced by scheduling of the cesarean section, obesity, skin closure type, diabetes or other chronic medical conditions. Although patients assigned chlorhexidine-alcohol were less likely to attend physician office visits, no other significant differences were seen among the various secondary outcomes.
The researchers wrote that these findings are consistent with the majority of studies comparing the two preparations and contrasts previous investigations linking chlorhexidine-alcohol to allergic reactions.
“This randomized, controlled trial showed that the use of chlorhexidine-alcohol for preoperative skin antisepsis at cesarean delivery was associated with a significantly lower risk of [SSI] than was the use of iodine-alcohol,” the researchers concluded. – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.