Chlorhexidine Versus Iodine Vaginal Preparation Prior to Hysterectomy; A Randomized Controlled Trial [11B

Abstract

INTRODUCTION: Currently we lack sufficient data for The American College of Obstetricians and Gynecologists to make recommendations regarding vaginal preparation solutions for hysterectomy. We designed a randomized controlled trial to compare the effectiveness of Chlorhexidine and Iodine. METHODS: Following Institutional Review Board approval, subjects undergoing hysterectomy via vaginal or endoscopic approach were randomized to 4% Chlorhexidine or 10% Iodine vaginal preparation. Vaginal cultures were obtained prior to preparation, then 30, 60 and 90 minutes thereafter. Primary outcome was the percent of samples with ≥5,000 bacteria (“positive culture”) at 90 minutes. Secondary outcomes included percent of samples ≥5,000 at 30 and 60 minutes, clearance of specific pathogens, postoperative complications, and surgical site infection rate. RESULTS: Eighty-five patients were randomized, average age 59.8 years (11.4) and median Charlson index score of 2 (0,6). Baseline percent ≥5,000 was no different (95.5% vs 100%; P=.495); 35.3% were positive for bacterial vaginosis. The Chlorhexidine group demonstrated a lower percentage of positive cultures at 90 minutes (47.6% vs 85.4%; P<.001), 30 minutes (27.3% vs 51.2%; P=.024) and 60 minutes (22.7% vs 70.7%; P<.001). Regarding specific pathogens, at 90 minutes, fewer subjects were positive for Staphylococcus in the Chlorhexidine group (5 vs 19; P=.035). There was no difference in the rate of urinary tract infection (15.9% vs 14.6%; P=.870), and no surgical site infections were documented. CONCLUSION: Chlorhexidine clears bacteria from the vagina more effectively and maintains a more aseptic surgical environment for 90 minutes. Gynecologic surgeons may consider switching to 4% Chlorhexidine from 10% Iodine for their vaginal preparation solution.