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No skin preparation solution is more beneficial or advantageous than others in reducing infection rates.
Surgical site infections are more common than expected among those who underwent gynecological laparoscopic surgery.
Uri Dior, MD, MPH, and a team of investigators conducted a double-blind randomized clinical trial between February 28, 2017, and November 26, 2018. They aimed to compare rates of port-site infections, organ or space infections, and any type of surgical site infections among patients who underwent gynecological laparoscopies and received 1 of 3 types of skin preparation solutions. The team found no solution provided an advantage over the others in reducing infection rates.
Dior and colleagues included patients at least 18 years old who underwent elective operative laparoscopy for the treatment of nonmalignant gynecological disorders. Those allergic to 1 of the skin preparation solutions were excluded, along with patients who had evidence of active infection or those who were unable to attend follow-up.
Patients were randomized at a 1:1:1 ratio to 1 of 3 groups: abdominal preparation with an alcohol-chlorhexidine solution and vaginal and vulvar preparation with aqueous-chlorhexidine solution, abdominal and vaginal and vulvar preparation with aqueous povidone-iodine solution, and abdominal preparation with an alcohol-povidone-iodine solution and vaginal and vulvar preparation with Aqu-PVP-I. Among the patients, 221 were randomized to have their skin prepared preoperatively with water-based povidone-iodine, 220 to alcohol-based povidone-iodine, and 220 to alcohol-based chlorhexidine. The patients were blinded to the solution use.
Staff painted the patient’s abdomen with the chosen solution from the rib margin to the top of the mons and laterally to the mid-point of the iliac crest. The vaginal and vulvar solution covered the mons, vulva, top 4 cm of the inner thighs, vagina, and the visible aspects of the buttocks. Solutions were able to evaporate.
The primary study outcome was to compare the rate of skin port-site infection among the 3 types of skin preparation. The investigators used criteria from the Centers for Disease Control and Prevention to define a skin infection as something occurring within 30 days after surgery, involving only skin or subcutaneous tissue of the incision, and including at least 1 of 4 criteria defined in the guideline. Additional outcomes included organ or space infections and total surgical site infection rates among the 3 types of preparation.
There were 1386 laparoscopies performed during the study. Overall, 640 patients with a mean age of 36.2 years old attended at least 1 follow-up visit and were included in the analysis. Of those included, 91.6% attended the second follow-up visit.
The rate of port-site infection was 10.2%, while the rate of organ or space infection was 6.6% and the rate of any surgical site infection was 16.3%. The odds ratio for infection for alcohol-based chlorhexidine versus water-based povidone-iodine was 1.13 (95% CI, .61-2.08). For alcohol-based chlorhexidine versus alcohol-based povidone-iodine, the odds ratio was 1.34 (95% CI, .71-2.52), while for water-based povidone-iodine versus alcohol-based povidone-iodine was 1.19 (95% CI, .62-2.27).
Overall, the investigators found surgical site infections were more common than expected. They concluded no skin preparation solution was more advantageous or beneficial compared with other solutions in reducing infection rates.
The study, “Effect of Surgical Skin Antisepsis on Surgical Site Infections in Patients Undergoing Gynecological Laparoscopic Surgery,” was published online in JAMA Surgery.