Comparison of chlorhexidine alcohol versus povidone iodine alcohol for pre-operative skin preparation in cesarean section to reduce the rate of surgical site infection.

Abstract

Objective: To compare the efficacy of chlorhexidine alcohol versus povidone iodine alcohol for pre-operative skin preparation in cesarean section to lower the rate of surgical site infection (SSI). Study Design: Randomized Controlled Trial. Setting: Gynaecology and Obstetrics Department Pakistan Institute of Medical Sciences, Islamabad. Period: July 2022 to December 2022. Methods: The study was conducted on a total of 360 patients booked for cesarean section presenting in Gynaecology & Obstetrics outpatient department PIMS who fulfilled the inclusion criteria. Two groups (A & B) were made and patients were randomly divided into the groups. In Group A, patients received chlorhexidine alcohol for pre-operative skin preparation and group B received povidone iodine alcohol for the same purpose. Post cesarean section patients were kept hospitalized for one week to observe for signs of surgical site infection and after discharge they were followed up for 30 days on weekly basis or as and when they develop symptoms of surgical wound infection. Results: Mean age of mothers in both groups remained to be 34.55±6.76. Overall mean duration of cesarean sections remained to be 39.59±5.85 minutes. Out of total 360 patients, 26 (7.2%) patients developed surgical site infection. Among them chlorhexidine alcohol group had 6 cases (23.1%) of SSI while there were 20 cases (76.9%) of SSI in Povidone Iodine group making it a statistically significant difference (p-value = 0.004). There was 20% frequency of infection among mothers having history of diabetes while 6.3% were those having no history of diabetes and difference is statistically significant. Conclusion: Chlorhexidine Alcohol is more effective in reducing the surgical site infection as pre-operative skin preparation solution in cesarean section as compared to the povidone iodine alcohol. History of diabetes among mothers was a significant risk factor for occurrence of SSI while obesity, parity, duration of surgery and age were not found out as risk factors in this study. Most of the infection occurred within ten days after cesarean section in present study.