Study Finds Compelling Evidence to Change Skin-Prep Practices for C-Section

The risk of infection for the chlorhexidine-alcohol group was almost halved
The risk of infection for the chlorhexidine-alcohol group was almost halved

Authors of a new study argue their findings provide sufficient evidence to change standard skin-prep practices for C-sections, in order to avoid the ongoing risk of infection. The study compared C-section patients who were prepped with iodine-alcohol and others prepped with chlorhexidine-alcohol. Results found that 4% of the chlorhexidine group suffered infection versus 7.3% of the iodine group.

The study – conducted by researchers at Washington University School of Medicine, St. Louis – included patients who underwent cesarean sections at Barnes-Jewish Hospital, from 2011 to 2015. In total, 1147 patients were included; 572 were randomly assigned to receive the chlorhexidine combination and 575 were randomly assigned to receive the iodine combination. Twenty-three in the chlorhexidine group developed an infection at the site of the surgery, while 42 did in the iodine group. Infections were counted if they occurred within 30 days of the surgery.

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The standard procedures for reducing the risk of infection after surgery were the same in both groups, including giving preventive antibiotics beforehand. Past studies have advocated the superiority of chlorhexidine, though the authors highlighted these studies had a low number of participants and they often compared chlorhexidine-alcohol combination with iodine alone.

Chlorhexidine-alcohol proved superior in cases whether the C-section was scheduled or unscheduled, whether or not the patient was obese, whether staples or sutures were used to close the wound and whether the patient had chronic medical conditions, including diabetes. The researchers also note that although the study was conducted in one hospital, the patient population was racially diverse.

In 2013, 5 to 12% of the estimated 1.3 million women who delivered babies through C-section in the US, had a surgical site infection. The average cost of treating these cesarean-related infections in hospital is $3,500. “There are few circumstances when a single study should change our practice,” said George A. Macones, MD, lead author of the study. “But based on the biological plausibility and the striking reduction in surgical-site infections with chlorhexidine, this is one of those circumstances."

For more information visit Washington University School of Medicine.

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