• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

Chlorhexidine or Iodine Based Skin Prep for Cesarean Sections?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE: 

  • Chlorhexidine–alcohol and povidone–iodine solutions are most commonly used for skin prep to pevent surgical site infections following cesarean section  
    • No clear recommendation regarding use of one over the other  
    • ACOG states (see ‘Related ObG Topics’ below) that “Chlorhexidine–alcohol is an appropriate choice” and that while iodophors also have broad spectrum coverage, they tend to be aqueous and not alcohol based  
  • Tolcher et al. (American Journal of Perinatology, 2019) compared chlorhexidine-alcohol with povidone-iodine solutions for skin antisepsis prior to cesarean delivery

METHODS: 

  • Systematic review and meta-analysis 
    • Database search of RCTs 
    • Endometritis excluded (ascending infection, not skin microbes)  
  • Skin prep performed with either 
    • Chlorhexidine-alcohol 
    • Povidone-iodine skin 
  • Primary outcome: Surgical site infection (CDC definitions)  
    • Superficial: Skin and subcutaneous tissue of the incision 
    • Deep wound infection: deep soft tissue layers of the incision (e.g., fascial and muscle layers) 
  • Secondary outomes  
    • Wound seroma | Hematoma | Skin separation | Skin reaction

RESULTS: 

  • 4 studies were included, totaling 3,059 women 
  • The chlorhexidine-alcohol group showed a significant reduction in surgical site infection rate  
    • Risk ratio (RR) 0.72; 95% CI: 0.52–0.98 
  • Subgroup analysis based on superficial or deep infection did not show a significant effect, although underpowered  
    • Superficial infection: RR 0.76; 95% CI, 0.54–1.08 
    • Deep infection: RR 0.50, 95% CI, 0.23–1.10 
  • No differences seen in secondary outcomes  
  • Comparisons using povidone-iodine without and without alcohol did not alter results

CONCLUSION: 

  • Chlorhexidine-alcohol prior to cesarean section lead to fewer surgical site infections when compared to povidone-iodine with or without alcohol  
  • Results support majority of studies in the general surgery literature  
  • Authors note that any alcohol-based scrub requires 3 minutes for drying (flammability risk) and povidone-iodine is a 2-step procedure 
    • Delay may not be possible for true obstetrical emergencies (e.g., cord prolapse)

Learn More – Primary Sources: 

Chlorhexidine–Alcohol Compared with Povidone–Iodine Preoperative Skin Antisepsis for Cesarean Delivery: A Systematic Review and Meta-Analysis

image_pdfFavoriteLoadingFavorite

< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

ACOG Guidance: Antibiotic Prophylaxis during Labor and Delivery
Can Evidence Based Interventions Reduce C-section Complications?
Chlorhexidine or Povidone-Iodine for abdominal hysterectomy?
ACOG Guidance on Preventing Gynecologic Post-Procedure Infection

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site