【新英格兰】Chlorhexidine–Alcohol versus PI for Surgical-Site Antisepsis

蓝鱼o_0

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


BACKGROUND
Since the patient’s skin is a major source of pathogens that cause surgical-site infection,
optimization of preoperative skin antisepsis may decrease postoperative infections.
We hypothesized that preoperative skin cleansing with chlorhexidine–alcohol
is more protective against infection than is povidone–iodine.
METHODS
We randomly assigned adults undergoing clean-contaminated surgery in six hospitals
to preoperative skin preparation with either chlorhexidine–alcohol scrub or
povidone–iodine scrub and paint. The primary outcome was any surgical-site infection
within 30 days after surgery. Secondary outcomes included individual types of
surgical-site infections.
RESULTS
A total of 849 subjects (409 in the chlorhexidine–alcohol group and 440 in the
povidone–iodine group) qualified for the intention-to-treat analysis. The overall
rate of surgical-site infection was significantly lower in the chlorhexidine–alcohol
group than in the povidone–iodine group (9.5% vs. 16.1%; P = 0.004; relative risk,
0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine–alcohol was significantly
more protective than povidone–iodine against both superficial incisional
infections (4.2% vs. 8.6%, P = 0.008) and deep incisional infections (1% vs. 3%,
P = 0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were
observed in the per-protocol analysis of the 813 patients who remained in the study
during the 30-day follow-up period. Adverse events were similar in the two study
groups.
CONCLUSIONS
Preoperative cleansing of the patient’s skin with chlorhexidine–alcohol is superior
to cleansing with povidone–iodine for preventing surgical-site infection after cleancontaminated
surgery. (ClinicalTrials.gov number, NCT00290290.)