COMPARATIVE STUDY OF CHLORHEXIDINE ALONE VERSUS CHLORHEXIDINE AND POVIDONE-IODINE FOR PRE-OPERATIVE SKIN PREPARATION AT CAESAREAN DELIVERY IN THE NIGER-DELTA REGION OF NIGERIA
ADEYINKA A.T1, OMO-AGHOJA L2*
1Department of Obstetrics and Gynecology, Delta State University Teaching Hospital, Oghara, Nigeria.
2Department of Obstetrics and Gynecology, Faculty of Clinical Medicine, College of Health Sciences, Delta State University, Abraka, Nigeria.
*Corresponding author:Prof. Lawrence Omo-Aghoja Email: eguono_2000@yahoo.com
Source of funding: None
Conflict of interest: None
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ABSTRACT
Background: Post-caesarean surgical-site infection (SSI) is an important cause of maternal morbidity and mortality, and the skin is an important source of pathogens in surgical wound infections.
Aims and Objectives: To determine if pre-operative skin preparation with sequential chlorhexidine and povidone-iodine has higher efficacy than chlorhexidine-only at reducing the incidence of post-cesarean SSI. Design of the study: Randomized comparative trial
Setting: Departments of Obstetrics and Gynecology, Delta State University Teaching Hospital, Oghara, and Central Hospital, Warri, Nigeria.
Materials and Methods: the study was conducted over eight months involving 570 participants who were randomized equally into either non-sequential arm utilizing 0.5%-chlorhexidine only, or sequential arm utilizing 0.5%-chlorhexidine followed by 10%-povidone-iodine. The primary outcome was occurrence of SSI within 30 days of surgery, while secondary outcomes were adverse skin reaction, prolonged length of post-Caesarean admission, and infection-related readmission. Analysis was performed using SPSS Version 22. Comparison of variables was by chi-square tests (or Fisher’s exact) for categorical variables, and Student’s t-test for continuous variables. Differences were considered significant if p-value <0.05.
Results: A total of 524 (91.9%) of the participants completed the study: 261 in the sequential and 263 in the non-sequential arms. There were no significant differences in the baseline characteristics among the women in the two groups. SSI was identified in 69 (13.2%) participants: 28 were in the sequential arm giving an SSI rate of 10.7% and 41 were in the non-sequential arm giving an SSI rate of 15.6% (p=0.100). There was no statistically significant difference between the two arms in the incidence of adverse skin reaction, 6 (2.3%) versus 4 (1.5%) (p= 0.544), prolonged length of stay, 4(1.5%) versus 7 (2.7%) (p=.367), and infection-related re-admission, 5 (1.9%) versus 8 (3.0%)(p= 0.407).
Conclusion: The use of sequential chlorhexidine-povidone-iodine antiseptic for pre-operative skin preparation at cesarean delivery was not superior to chlorhexidine alone in reducing the incidence of post-Caesarean SSI. Therefore, we recommend that chlorhexidine gluconate should be the antiseptic agent of choice for cesarean delivery, until further studies dictate a superior antiseptic protocol.
Key words:Surgical site infections, Povidone-iodine, Chlorhexidine, Skin-preparation, Caesarean delivery.
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