Chlorhexidine-Alcohol Compared With Povidone-Iodine for Surgical-Site Antisepsis in Cesarean Deliveries

Abstract

OBJECTIVE: To estimate the incidence of surgical-site infection with use of chlorhexidine-alcohol compared with povidone-iodine among women undergoing cesarean deliveries. METHODS: This was a retrospective cohort review of 1,000 consecutive cases in women who underwent cesarean delivery over a 1-year interval. The primary outcome was any surgical-site infection within 30 days (Centers for Disease Control and Prevention criterion). RESULTS: Mean age and parity were equivalent (29.865.9 years; 2.661.4). Women were similar regarding baseline characteristics, including acknowledged surgical-site infection comorbidities (body mass index [BMI, calculated as weight (kg)/[height (m)] 2 ], gestational diabetes, smoking; P..05). Method of skin incision closure was different, with 91% among povidine-iodine compared with 81% among chlorhexidine-alcohol using staples (P,.001). Although the duration of surgical time was higher among chlorhexidine women (67.2 compared with 60.0 minutes; P,.001), fewer women in the chlorhexidine group were classified as having undergone an “urgent” cesarean delivery (29% compared with 46%; P,.001). Concerning surgical-site infection, the overall rate was similar between the two groups (5% [n525] chlorhexidine and 5.8% [n529] povidone-iodine; P5.58). In multivariable analysis and after control for potential confounders, odds for surgical-site infection remained similar between the two groups (adjusted odds ratio 0.74, 95% confidence interval 0.41–1.33; P5.32). The only significant predictor of surgical-site infection was duration of cesarean delivery, in which every 1-minute increase in duration increased the odds for infection by 1.3% (adjusted odds ratio 1.013, 95% CI 1.004–1.022; P5.004). CONCLUSION: The single significant predictor of surgical-site infection is operative time. Cleansing with povidone-iodine may be a cost-effective and equally efficacious alternative to chlorhexidine-alcohol among women undergoing cesarean deliveries.