ANTISEPTIC SKIN PREPARATION FOR PREVENTING SURGICAL SITE INFECTION AT CAESAREAN SECTION: A RANDOMISED CONTROL TRIAL

Abstract

Background: Caesarean section is the most common major obstetric surgical
procedure performed on women. Surgical site infections complicate up to 5
10% of all caesarean sections and result in significant human suffering and
excess health care costs. Interventions such as prophylactic antibiotic reduce
surgical site infections, but the rate of infection remains high. There is
therefore a need to identify and test other potential interventions to further
reduce the incidence of surgical site infections.
Objective: The aim of this randomised control trial was to compare the effect
of two different antiseptic skin preparations; chlorhexidine-alcohol and
povidone iodine on surgical site infection rates after caesarean section and
to determine the rate of skin reactions to both antiseptic skin preparation.
Methodology: A total of 374 patients (188 in the chlorhexidine-alcohol group
and 186 in the povidone iodine group) who had elective caesarean section
with no overt risk factor for surgical site infection were recruited. They
underwent caesarean section based on the same technique. A proforma
was designed to collect information on sociodemographic and obstetric
characteristics and neonatal outcome. Patients were contacted at intervals
up to thirty days from delivery, to assess symptoms and signs of surgical site
infection and they were treated as appropriate.
Results: Fifty-one (13.6%) of the total study population developed surgical site
infection. There was however no statistically significant difference between
the chlorhexidine-alcohol group and the povidone iodine group (12.2% vs
15.1%; p=0.26). Thirty seven (66.7%) of the SSI was of the superficial type and
the most cultured organism was Staphylococcus aureus.
Chlorhexidine–alcohol had a lower adverse skin reaction profile than
povidone iodine (4.0% vs 5.4%; p=0.40). The skin reaction seen were pruritus
and erythema with none being life threatening.
Conclusion: This prospective study demonstrates that antisepsis with
chlorhexidine-alcohol was associated with a lower rate of SSI compared to
povidone-iodine antisepsis in patients undergoing elective caesarean section
and that chlorhexidine-alcohol has a better side effect profile. However,
these differences were not statistically significant.

ANTISEPTIC SKIN PREPARATION FOR PREVENTING SURGICAL SITE INFECTION AT CAESAREAN SECTION: A RANDOMISED CONTROL TRIAL