Surgical site infections are the most common healthcare associated infection. While often preventable, they are associated with substantial morbidity and mortality as well as prolonged hospitalizations and readmissions, and continue to be a global health challenge.
Among the millions of patients undergoing surgical procedures annually in the U.S., an estimated 3% will develop surgical site infections compared with nearly a quarter of patients in low- and middle-income countries. These infections offer a key quality metric in health care, but they can also be the difference between having a successful postoperative outcome or not.
Anthony Charles, MD, MPH, Director Global Surgery at the Institute for Global Health and Infectious Diseases, wrote a commentary on a study published in JAMA this month that compared povidone iodine to chlorhexidine gluconate, in alcohol, in preventing infections after cardiac or abdominal surgery.
This multicenter, cluster-randomized trial enrolled 3,360 patients undergoing cardiac (65%) or abdominal (35%) operations across three tertiary care hospitals in Switzerland, measuring surgical site infections within 30 days of abdominal surgery, and up to one year after cardiac surgery. Although the efficacy of preoperative skin antiseptics for preventing infections is well established, there has been ongoing debate about which antiseptic is most effective for preventing surgical site infections.
In this study, surgery site infections were identified among 5.1% of patients given povidone iodine compared to 5.5% in the chlorhexidine gluconate group.
“These results are contrary to current WHO guidelines that recommend chlorhexidine-alcohol over aqueous povidone iodine, or povidone iodine with alcohol, for surgical skin preparation. Therefore, this study should prompt a change in WHO guidance.”
“Additional studies should also be performed in low- and middle-income countries and other resource-limited settings, to build on this work, particularly because the reported surgery site infection rate of 5% among Swiss tertiary care hospitals may not be broadly representative,” said Charles, who is also Chief of the UNC’s Division of General and Acute Care Surgery.