ANTISEPTIC SKIN PREPARATION FOR PREVENTING SURGICAL SITE INFECTION AT CAESAREAN SECTION: A RANDOMISED CONTROL TRIAL

Background: Caesarean section is the most common major obstetric surgical procedure performed on women. Surgical site infections complicate up to 510% of all caesarean sections and result in significant human suffering and excess health care costs. Interventions such as prophylactic antibiotic reduce surgical site infections, but the rate of infection remains high. There is therefore a need to identify and test other potential interventions to further reduce the incidence of surgical site infections. Objective: The aim of this randomised control trial was to compare the effect of two different antiseptic skin preparations; chlorhexidine-alcohol and povidone iodine on surgical site infection rates after caesarean section and to determine the rate of skin reactions to both antiseptic skin preparation. Methodology: A total of 374 patients (188 in the chlorhexidine-alcohol group and 186 in the povidone iodine group) who had elective caesarean section with no overt risk factor for surgical site infection were recruited. They underwent caesarean section based on the same technique. A proforma was designed to collect information on sociodemographic and obstetric characteristics and neonatal outcome. Patients were contacted at intervals up to thirty days from delivery, to assess symptoms and signs of surgical site infection and they were treated as appropriate. Results: Fifty-one (13.6%) of the total study population developed surgical site infection. There was however no statistically significant difference between the chlorhexidine-alcohol group and the povidone iodine group (12.2% vs 15.1%; p=0.26). Thirty seven (66.7%) of the SSI was of the superficial type and the most cultured organism was Staphylococcus aureus. ix Chlorhexidine–alcohol had a lower adverse skin reaction profile than povidone iodine (4.0% vs 5.4%; p=0.40). The skin reaction seen were pruritus and erythema with none being life threatening. Conclusion: This prospective study demonstrates that antisepsis with chlorhexidine-alcohol was associated with a lower rate of SSI compared to povidone-iodine antisepsis in patients undergoing elective caesarean section and that chlorhexidine-alcohol has a better side effect profile. However, these differences were not statistically significant.