CHLORHEXIDINE VERSUS POVIDONE-IODINE SKIN ANTISEPSIS FOR PATIENTS UNDERGOING CESAREAN SECTION IN REDUCTION OF SURGICAL SITE INFECTION: A RANDOMIZED CONTROLLED TRIAL

Abstract

Summary C esarean birth is one of the most frequently performed major surgical procedures world wide. Cesarean delivery rates increased across racial and ethnic, geographic, maternal age and infant gestational age strata. Apart from increased medical costs for cesarean delivery compared with vaginal delivery, surgical site infection (SSI) remains a substantial cause of postoperative morbidity and increased health care cost because of maternal readmission. The use of preoperative skin antisepsis is an important intervention aimed at reducing the risk for SSI. It decrease the concentration of bacteria colonizing the skin, with the goal of sterilizing the surgical field. The use of skin antisepsis is recommended by professional and public health organizations, including the Royal college of surgeons of England, the centers for disease control & prevention. The purpose of this study is to compare use of chlorhexidine with use of Povidone- iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infection. The study was conducted in Ain Shams University Maternity Hospital and in the Department of obstetric and Gynecology of Manshiet El-Bakry General Hospital, Cairo during the period from Jun 2014 to Dec 2014. The study was an interventional prospective randomized controlled clinical trial compared the effectiveness of using chlorhexidine based anti sepsis versus Povidone –Iodine in reduction of surgical site infection. Patient selection and management: Inclusion criteria: 1. Patient 18 years of age or older who will undergo cesarean deliveries who are at term (37wks-41wks of gestation). 2. Body mass index (BMI) between 20-35kg/m2. 3. Able to communicate well with the investigator and to comply with the requirements of the entire study. Exclusion criteria: 1. Rupture of membranes. 2. Patients who have history of allergy to chlorhexidine, alcohol and iodophors. 3. Documented concomitant infections like: a- Chorioamnionitis b-Pyelonephritis c- Urinary tract infection. d- Mastitis: 405 patients were randomly distributed according to computer generated randomization sheet into two groups: Study group: (group A) 204 patients: each patient were prepared similarly by three applications of 2%chlorhexidine solution followed by drying with a sterile towel and three applications of 70% alcohol. Control group (group B) 201 patients: each patient were scrubbed preoperatively with an applicator that contain 10% povidone-iodine scrub solution (three consecutive applications), followed by drying with sterile towel and three application of 10% povidone-iodine in 70 % alcohol). All women were subjected to elective or non elective CS& gave an informed consent. Both groups preoperatively were subjected to: 1- Medical history. 2- Physical examination. 3- Routine investigation (CBC-Kidney function-Liver function-Random blood Sugar). All patients in both groups received a single dose of intravenous (®Cefotriaxone 1gm) after sensitivity test as prophylactic antibiotic before the operation by one hour. All cases was preformed with senior registrar with estimation of the operative duration. Both groups postoperative were subjected to: - The incisional site wound dressing were preformed before hospital discharge in the 1st 48 hrs with alcohol and stripad. - All patients asked &examined about post operative symptoms & signs suggesting of surgical site infection with in the first week. - They were rescheduled for aclinic visit after 30 days with assessment of SSI, allergic reaction, Hospital readmission, febrile morbidity, endometrities and secondary postpartum haemorrage. - In this study there was no statistically significant difference could be detected between both groups as regard the age, weight, height, BMI, past history of abdominal surgery and parity. - There was no statistically significant difference between both studied groups as regard type of CS or operative time of delivary.