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.
