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Chlorhexidine-Alcohol Compared With Povidone-Iodine for Preoperative Topical Antisepsis for Abdominal Hysterectomy

Uppal, Shitanshu MBBS; Bazzi, Ali MD; Reynolds, R. Kevin MD; Harris, John MD, MSc; Pearlman, Mark D. MD; Campbell, Darrell A. MD; Morgan, Daniel M. MD

doi: 10.1097/AOG.0000000000002130
Contents: Original Research

OBJECTIVE: To compare preoperative chlorhexidine-alcohol topical antiseptic agent with povidone-iodine in patients undergoing abdominal hysterectomy for benign indications.

METHODS: A retrospective cohort study of patients undergoing abdominal hysterectomy from July 2012 to February 2015 in the Michigan Surgical Quality Collaborative was performed. The primary exposure was the use of chlorhexidine-alcohol or povidone-iodine. The primary outcome was surgical site infection within 30 days. Multivariable logistic regression and propensity score matching analysis were done to estimate the independent association of skin antiseptic choice on the rate of surgical site infection.

RESULTS: Of the total 4,259 abdominal hysterectomies included, chlorhexidine-alcohol was used in 70.5% (n=3,005) and povidone-iodine in 29.5% (n=1,254) of surgeries. The overall unadjusted rate of any surgical site infection was 2.9% (95% CI 2.5–3.5; n=124). The unadjusted rate of surgical site infection 2.6% (95% CI 2.1–3.3; n=79) for chlorhexidine-alcohol and 3.6% (95% CI 2.7–4.8; n=45; P=.09) for the povidone-iodine group. Using multivariate logistic regression and adjusting for differences between populations in patient demographic factors (age and body mass index), medical comorbidities (American Society of Anesthesiologists class and diabetes status), perioperative variables (estimated blood loss, surgical time, intraoperative adhesions, and antibiotic categories), and hospital characteristics (bed size and teaching status), we estimate that patients receiving chlorhexidine-alcohol had 44% lower odds of developing a surgical site infection (adjusted odds ratio 0.56, 95% CI 0.37–0.85, P=.01). Propensity score matching (one to one) yielded 808 patients in the chlorhexidine-alcohol group and 845 patients in the povidone-iodine group. In the matched groups, the rate of surgical site infection was 1.5% (95% CI 0.8–2.6; n=12) for the chlorhexidine-alcohol group and 4.7% (95% CI 3.5–6.4; n=40) for the povidone-iodine group (P<.001).

CONCLUSION: In abdominal hysterectomy performed for benign indications, chlorhexidine-alcohol-based skin antisepsis is associated with overall lower odds of surgical site infection compared with povidone-iodine.

Compared with povidone-iodine, the use of chlorhexidine-alcohol topical antiseptic during abdominal hysterectomy for benign indications was associated with a 40% lower incidence of surgical site infection.

Departments of Obstetrics & Gynecology and Surgery and the Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, and the Department of Obstetrics and Gynecology, St. John Hospital and Medical Center, Detroit, Michigan.

Corresponding author: Shitanshu Uppal, MBBS, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as an oral plenary during the Society of Gynecologic Surgeons’ 42nd annual meeting, April 10–13, 2016, Palm Desert, California.

The authors thank Dr. Karen McLean and the Michigan Gynecologic Oncology Workgroup for their feedback on this project and Sarah Block for her editorial assistance.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.