Comparison of the Efficacy of Chlorhexidine Gluconate versus Povidone Iodine as Preoperative Skin Preparation for the Prevention of Surgical Site Infections

Title: Comparison of the Efficacy of Chlorhexidine Gluconate versus Povidone Iodine as Preoperative Skin Preparation for the Prevention of Surgical Site Infections

Authors: Dr Mohd. Rafik Rao, Dr Ashok Kumar, Dr Mahendra Jalthania, Dr Bhupendra Sharma, Dr Sundar, Dr Parikshit

DOI: https://dx.doi.org/10.18535/jmscr/v5i4.85

Abstract

Background: Infections that occur in the wound created by an invasive surgical procedure are generally referred as surgical site infections (SSIs). The microorganisms that cause SSIs are usually derived from the patient (endogenous infection), being present on their skin or from an opened viscous. Preoperative skin preparation of the surgical site using appropriate antiseptic products is one of the important interventions to prevent SSIs. SSIs can double the length of time a patient stays in hospital and thereby increase the costs of health care. The aim of this study To compare efficacy of Povidone Iodine and Chlorhexidine Gluconate with help of sterile saline swab culture of SSIs.

Methodology: Patients were randomly divided in Group I & Group II each group having equal number of patients undergoing elective clean & clean-contaminated surgeries. The pre operative skin preparation is done with povidone iodine IP 5% w/v in group-I & chlorhexidine gluconate 5% v/v in aqueous base in group II. In both the groups sterile saline swab culture were taken from the incision site pre-painting as well as post-painting.

Results: A total of two hundred surgical cases included in study and age ranges from 14 to 80 years and male:female ratio was 1.24 :1 and bacterial growth in prepainting period in povidone iodine group was 81.70% while in chlorhexidine group is 99.15% which is statistically insignificant and in postpainting period in povidone iodine group 4.8% while in chlorhexidine group is 1.6% which is statistically significant.

Conclusion: Hence it can be safely concluded that chlorhexidine aquaous was associated with reduced risk of postoperative SSI in clean and clean-contaminated surgery when compared to Povidone Iodine. Further studies should evaluate the effectiveness of CHG versus PI in reducing SSI across contaminated surgery.

Keywords: Surgical site infections, Chlorhexidine, Povidone iodine, Painting.

References

1. Smyth ET, McIlvenny G, Enstone JE, et al. Four Country Healthcare Associated Infection Prevalence Survey 2006: overview of the results. Journal of Hospital Infection 2008;69:230–48.

2. Department of Health CMO. Winning Ways: Working Together to Reduce Healthcare Associated Infection in England.London: Department of Health; 2003.

3. Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surgical Clinics of North America. 1980;60:27–40.

4. Mannien J, Wille JC, Snoeren RL, et al. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands. Infection Control and Hospital Epidemiology. 2006;27:809–16.

5. Whitby M, McLaws ML, Collopy B, et al. Post-discharge surveillance: can patients reliably diagnose surgical wound infecti-ons? Journal of Hospital Infection. 2002;52:155–60.

6. Astagneau P, Rioux C, Golliot F, et al. Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. Journal of Hospital Infection 2001;48:267–74.

7. Bayat A, McGrouther DA, Ferguson MW. Skin scarring. British Medical Journal 2003;326:88–92.

8. National Collaborating Centre for Wom-en's and Children's Health.National Institute for Health and Clinical Excel-lence: guidance. Surgical site infection: prevention and treatment of surgical site infection. RCOG Press, London (2008).

9. Reichman DE, Greenberg JA. Reducing Surgical Site Infections: A Review. Reviews in Obstetrics and Gynecology. 2009;2(4):212-221.

10. Digison MB. A review of antiseptic agents for pre-operative skin preparation. Plast Surg Nurs.2007;27:185–189.

11. Hibbard JS. Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review. J Infus Nurs. 2005;28:194–207.

12. Patrick JC, Kari K, Miles M, Blackwell L, James S. A randomized trial that compared povidone iodine and chlorhexidine asantiseptics for vaginal hysterectomy. American Journal of Obstetrics and Gynecology 2012 Feb; 192(2):422-5.

13. Anjanappa T. H, Arjun A. Preparative Skin Preparation And Surgical Wound Infection. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 2, January 12, 2015; Page: 131-154.

14. Leaper DJ, van Goor H, Reilly J, Petrosillo N, Geiss HK, Torres AJ, et al. Surgical site infection - a European perspective of incidence and economical burden. Int Wound Journal 2004; 1(4): 247-273.

15. DiPiro JT, Martindale RG, Bakst A, Vacani PF, Watson P, Miller MT. Infection in surgical patients: effects on mortality, hospitalization, and postdischarge care. Am J Health Syst Pharm 1998; 55(8): 777-81.

16. Matin ASMR. Wound Infection in Planned Abdominal Surgery. (Dissertation), Bangladesh College of Physicians and Surgeons, 1981. 10.

17. Haddad V, Macon WLN. Abdominal Wound Dehiscence and Evisceration: Contributing factors and improved mortality, Br J Surg. 1980;16:508-13.

18. James F. Connell and Louis M. Rousselot. 1964, Dec. “Povidone-Iodine: Extensive surgical evaluation of a new antiseptic agent.” American Journal of Surgery. 108: 849-855.

19. Hugo W.B. and Longworth A.R. 1964. “Some aspects of the mode of action of chlorhexidine.” Brit. J. Pharm. Pharmacop. 16: 658.

20. Ranjeet A. Patil “A Comparative Study Of Chlorhexidine-Alcohol Versus Povidone-Iodine For Surgical Site Antisepsis In Clean & Clean Contaminated Cases” Journal of Medical Thesis 2013 July-Sep; 1(1) : 33.

21. Darouiche RO, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010 362: 18–26.

22. Ingi Lee, Rajender K. Agarwal, Bruce Y. Lee Neil O. Fishman, Craig A. Umscheid. Systematic Review and Cost Analysis Comparing Use of chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection. Infection Control & Hospital Epidemi-ology. Dec.,2010, Vol 31(12):1219-1229.

23. Grabsch E.A., Mitchell D.J., Hooper J.and Turnidge J.D. “In use efficacy of a chlorhexidine in alcohol surgical sub: a comparative study.” ANZ J Surg.2004; 74(9): 769-72.

24. Brown T.R., Clarence E. Ehrlich, Frederick B. Stehman, Alan M. Golichowski, James A. Madura and Harold E.E. 1984. “Clinical evaluations of chlorhexidine gluconate spray as compared with iodophor scrub for preoperative skin preparation.” Surgery, Gynecology and Obstetrics; 158(4):363.

25. V. Paocharoen, C. Mingmalairak, A. Apisarnthanarak: Comparison of surgical wound infection after preoperative skin preparation with 4% chlorhexidine [correction of chlohexidine] and povidone iodine: a prospective randomized trial; J Med Assoc Thai, 92 (7) (2009), pp. 898–902.

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Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles