Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis

Rabih O Darouiche, Matthew J Wall, Kamal M F Itani, Mary F Otterson, Alexandra L Webb, Matthew M Carrick, Harold J Miller, Samir S Awad, Cynthia T Crosby, Michael C Mosier, Atef Alsharif, David H Berger
New England Journal of Medicine 2010 January 7, 362 (1): 18-26

BACKGROUND: Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine.

METHODS: We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections.

RESULTS: A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups.

CONCLUSIONS: Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. ( number, NCT00290290.)

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Antonio Guimaraes

Always prefered chlorohexedine.


Tashique Alam

Finally a definitive result



We use both povidone iodine and alcohol,
Iodine first , let it dry and then use alcohol. May its worth another trial the effectiveness of combination with either povidone iodine or alcohol. Safi ur Rehman.


Imtiaz Ahmed

Contrary to common practice. Preop preparation needs change.


Muhammad Ibrahim

Using both is a better option specially those rare people having allergy to povidone iodine


Malan Malumani

the institution am currently afiliated to,we use povidone-iodine paint and from my observation we have not had any post operative infection.I am of the view that other factors are at play not only the skin pathogens.


Amik Munankarmy

Preoperatively we use iodine for painting and at the end of closure we dress with alcohol


Glen Farrow

What about the risk of diathermy burns from ignition of pooled alcohol. This is an uncommon but well known risk with alcoholic skin prep. I think some still prefer aqueous for that reason


Fermin Lobo

En Honduras primero lavamos la piel con jabón de clorhexidina alcohol y luego aplicamos una pintura de yodopovidona. En otras palabras usamos los dos métodos.


Bijoy Abraham

Chlorhex alcohol dries much faster , especially if your using stick on drapes instead of cloth drapes.


Carmen Ruiz

How about alcoholic betadine?


Melvin Sánchez

Los odontólogos en Perú prefieren la Clorhexidina


Chuanxue Zhang



Artevsovs Gambiza

Alcoholic beta dine baths are very effective on the recovery of deep industrial burns and can expedite tissue replacement if applied daily under simultaneous cognitive pain management.


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