A Comparison of Chlorhexidine-Alcohol Versus Povidone-Iodine for Eliminating Skin Flora Before Genitourinary Prosthetic Surgery: A Randomized Controlled Trial (original) (raw)
Related papers
Urethral instillation of chlorhexidine gel is an effective method of sterilisation
Arab Journal of Urology
Objective: To examine the effectiveness of preoperative urethral sterilisation with chlorhexidine gel in rendering the urethra as sterile as the skin of the genital area, with the skin sterilised as per the International Society for Sexual Medicine guidelines for penile prosthesis implantation. Patients and methods: A total of 111 male patients undergoing sterile andrological surgical procedures were divided into a control group (N = 61) and a chlorhexidine gel group (N = 50). Patients in the chlorhexidine group received urethral instillation with 6 mL of chlorhexidine preoperatively and on table. Patients from both groups received on-table skin preparation using povidone iodine and chlorhexidine povidone iodine. At the end of surgery, swabs were obtained from urethra and the penile skin. Skin and urethral swabs were compared for bacterial colonisation by culture and sensitivity. Results: Of the 111 patients, 16 had urethral colonisation and 10 had skin contamination, and they were all in the control group. The most common organism detected in both the urethral and skin samples was coagulase-negative Staphylococcus aureus. Urethral colonisation was significantly greater in the control group compared to the chlorhexidine group, at 16/61 vs 0/ 50 (P = 0.001). Similarly, skin colonisation was significantly greater in the control group compared to the chlorhexidine group, at 10/61 vs 0/50, (P = 0.002). Conclusion: Chlorhexidine gel is a powerful sterilising agent that will render the urethra sterile.
The Journal of Sexual Medicine, 2019
Introduction The Mulcahy salvage fundamentally altered the management of penile prosthesis infections (PPI). Central to this procedure is a sequence of antiseptic irrigations that aims to remove and eradicate pathogenic microflora from the infected field, thus preparing for immediate reimplantation. The antiseptic solutions and their respective concentrations, however, have never been evaluated for efficacy. Aim This review critically examines 3 commonly used antiseptic irrigation solutions (povidone-iodine [PVI], hydrogen peroxide [H2O2], and chlorhexidine gluconate [CHG]) in terms of their antimicrobial activity, cytotoxicity, and clinical use. Methods A PubMed literature review was performed on articles published between 2003 and 2018. Both preclinical as well as clinical studies from various surgical disciplines were included in this review. Main Outcome Measure The original salvage protocol selected for irrigation solutions at concentrations that are likely detrimental to nativ...
2018
Objective: To compare chlorhexidine-alcohol and povidone-iodine in terms of frequency of surgical site infection when applied prior to surgical incision in clean contaminated cases.Study Design: Randomized controlled trial.Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi from Feb 2014 to Feb 2015.Material and Methods: Eight hundred and forty consecutive patients undergoing abdominal surgery, who fulfilled inclusion criteria, were included in this study after taking written informed consent. They were divided into two equal groups of 420 patients each. In “group A” chlorhexidine alcohol and in “group B” povidone iodine was used for skin preparation.Results: Rate of surgical site infection was significantly low 8.6% in chlorhexidine alcohol group as compared to 13.8% in povidone iodine group (p=0.016).Conclusion: Chlorhexidine alcohol solution is superior to povidone iodine in reducing surgical site infection when used for preparing sk...
The aim of the present study is to evaluate the efficacy of povidone iodine alone and in combination with antiseptic agent containing alcoholic chlorhexidine in preoperative skin preparation by taking swab culture and to compare the rate of postoperative wound infection in both the groups. Patients and methods: This hospital based comparative study includesSixty Patients (Thirty in each Group) with no focus of infection on the body undergoing clean elective surgery at Siddhartha Medical College and General Hospital from 1 st July 2017 to28 th February 2018. Results: When compared to povidone iodine alone, using a combination of povidone iodine and alcoholic solution of chlorhexidine, wound infections were lesser and the colonization rates of the site of incision were reduced significantly. Hence Preoperative skin preparation with chlorhexidine gluconate 2.5% v/v in 70% propanol followed by aqueous povidone-iodine is an ideal regime as it has a broader antimicrobial spectrum and the rate of postoperative wound infections is much lower as compared to povidone iodine alone.
JPMA. The Journal of the Pakistan Medical Association, 2015
To compare the efficacy of povidone-iodine and chlorhexidine gluconate scrubs in preventing surgical site infections. The randomised controlled clinical trial was conducted from May 2012 to April 2013 in two public-sector hospitals of Pakistan; one each in Karachi and Islamabad. Patients undergoing clean or clean contaminated surgeries were included and were randomly assigned to one of the two groups: group I comprised patients whose skin was preoperatively disinfected using 10% povidone-iodine, and in group II by 2% chlorhexidine gluconate in 70% alcohol. A predesigned proforma was filled for all patients to record demographic data, diagnosis, surgical procedure and antibiotic used. Patients in both groups were followed up for one month postoperatively to monitor any signs of surgical site infections. SPSS 16 was used for statistical analysis. Of the 388 patients from the two hospitals, 220(57%) were in group I and 168(43%) were in group II. Surgical site infection was observed in ...
Journal of Innovative Science, 2020
One of the major causes of surgical site infection (SSI) is an inappropriate surgical site preparation that leads to postoperative complications. Although preoperative skin preparation is a standard surgical practice to prevent SSI, the choice of skin disinfectants and methods of skin preparation is still aberrant in veterinary practice. The study was, thus, conducted to standardize pre-surgical skin preparation with various formulations of Chlorhexidine gluconate, Chlorxylenol, and Povidone-iodine (PI) in goat. Seven surgical fields were prepared for evaluating seven formulations of these antiseptics. The bacterial swabs collected at different stages of skin preparations were transferred in nutrient broth and cultured in Plate Count Agar for counting of Colony Forming Unit (CFU). Results revealed that Chlorxylenol was less efficacious than PI and Chlorhexidine gluconate when mean CFU was counted at different stages of surgical field preparation. Soap water scrubbing and ethanol spray followed by aqueous Chlorhexidine gluconate painting eliminated 100% bacterial load and kept the site aseptic for 60 min. On the other hand, alcoholic Chlorhexidine gluconate completely removed bacterial burden from the skin and maintained 90 min long aseptic condition of the operation site. Based on our findings, alcoholic Chlorhexidine gluconate was the best in producing an aseptic surgical field for a longer duration. Our findings recommend robust scrubbing of the surgical site with detergent or soap water followed by 70% ethanol or hexisol spray and then painting the site with antiseptic preferably with alcoholic Chlorhexidine gluconate solution to generate aseptic surgical site which is very basic to prevent SSI and postoperative complications.
Annals of Surgery, 2020
Objective: There is uncertainty around preoperative skin antisepsis in clean surgery. Network meta-analysis provides more precise estimates than standard pairwise meta-analysis and can rank interventions by efficacy, to better inform clinical decisions. Background: Infection is the most common and costly complication of surgery. The relative efficacy of CHG and PVI based skin antiseptics in clean surgery remains unclear. Methods: We searched for randomized or nonrandomized studies comparing the effect of different preparations of CHG and PVI on the dichotomous outcome of surgical site infection. We included studies of adults undergoing clean surgery. We excluded studies concerning indwelling vascular catheters, blood sampling, combination antiseptics or sequential applications of different antiseptics. We performed a network meta-analysis to estimate the relative efficacy of interventions using relative risks (RR). Results: We included 17 studies comparing 5 antiseptics in 14,593 individuals. The overall rate of surgical site infection was 3%. Alcoholic CHG 4%-5% was ranked as the most effective antiseptic as it halved the risk of surgical site infection when compared to aqueous PVI [RR 0.49 (95% confidence interval 0.24, 1.02)] and also to alcoholic PVI, although uncertainty was larger [RR 0.51 (95% confidence interval 0.21, 1.27)]. Adverse events related to antiseptic application were only observed with patients exposed to PVI. Conclusions: Alcoholic formulations of 4%-5% CHG seem to be safe and twice as effective as PVI (alcoholic or aqueous solutions) in preventing infection after clean surgery in adults. Our findings concur with the literature on contaminated and clean-contaminated surgery, and endorse guidelines worldwide which advocate the use of alcoholic CHG for preoperative skin antisepsis. Registration: PROSPERO ID CRD42018113001.