Monday, June 19, 2017

What is best for Cesarean Antisepsis? Chlorhexidine-Alcohol versus Povidone-Iodine.


Chlorhexidine-Alcohol is not superior to Povidone-Iodine in reducing the rate of surgical site infection in Cesarean section reports the results of Chlorhexidine-Alcohol Versus Povidone-Iodine for Cesarean Antisepsis (CAPICA) Trial published ahead of print in American Journal of Obstetrics and Gynecology.

Wound infection after a cesarean section (CS) is a major cause of maternal morbidity, lengthy hospital stays and increased medical cost. The rate of surgical site infection after cesarean section range from 3% to 15%.

Researchers and investigators are always looking at ways to minimize the surgical site infection in cesarean section. Numerous interventions have been proposed from changing gloves at timeof abdominal closure to preoperative antibiotic prophylaxis.

But, no previous randomized control trial has compared chlorhexidine-alcohol to povidone-iodine aqueous scrub and paint in reduction of cesarean-related surgical site infections (SSIs).

The CAPICA Trial is the first single center pragmatic randomized trial conducted at urban tertiary care center over a period of 3+ years. The trial compared efficacy of 26ml chlorhexidine-alcohol applied as single step versus 236mL povidone-iodine aqueous scrub as preoperative skin preparation in cesarean section in reducing the SSIs.

The trial recruited 932 study participants, who were 18 years or older, with no chorioamnionitis, non-allergic to povidone iodine or alcohol and who were ready to be compliant with the follow up protocols.

Women who had elective cesarean section as well as those who had emergency cesarean sections were included in the study. 

Statistical analysis was performed to look at categorical and continuous outcomes in comparing incidence of superficial or deep SSIs or endometritis as defined by CDC, including allergic skin reactions, hematomas, wound separation, dehiscence.

461 women were assigned to chlorhexidine-alcohol, and 471 assigned to povidone-iodine group. About 97% to 99% women came for follow up at 30 days. SSIs occurred in 7% of women in the povidone-iodine group vs 6.3% chlorhexidine-alcohol group(p=0.38).

Individually the difference in sub-component of infections are: superficial surgical site infection (4.6% v 5.5%, p=0.55), deep surgical site infection (0.0% v 0.4%; p=0.50), and endometritis (1.7% v 1.1%; p=0.42) in chlorhexidine-alcohol versus povidone-iodine arms respectively.

The authors concluded that use of chlorhexidine-alcohol does not results in less frequent infections as compared to using povidone-iodine.



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