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Povidone Iodine versus Chlorhexidine in Skin Antisepsis before Elective Plastic Surgery Procedures: A Randomized Controlled Trial

2008; Lippincott Williams & Wilkins; Volume: 122; Issue: 5 Linguagem: Inglês

10.1097/prs.0b013e318186cd7f

1529-4242

Daniela Francescato Veiga, Carlos Américo Veiga Damasceno, Joel Veiga-Filho, Ricardo Góes Figueiras, Roberto Bezerra Vieira, F Florenzáno, Yára Juliano, Lydia Masako Ferreira,

Surgical Sutures and Adhesives

Sir: One of the most important risk factors for surgical-site infection is the presence of bacteria in the wound at the time of surgery. Thus, the purpose of preoperative skin preparation is to reduce bacteria on the skin before making an incision.1,2 The antiseptics most commonly used for antisepsis of the operative field include povidone-iodine, chlorhexidine, and their ethanolic solutions.3 The aim of the present study was to compare povidone-iodine and chlorhexidine ethanolic solutions for skin antisepsis before plastic surgery procedures. Two hundred fifty patients older than 18 years of age, scheduled for elective and clean plastic surgery procedures (i.e., breast reconstruction, mammaplasty, breast prosthesis, abdominoplasty, scar revision, zetaplasty, lipoma exeresis, gynecomasty, and supernumerary mamma) were assigned randomly to the povidone-iodine group (n = 125) or the chlorhexidine group (n = 125). The antisepsis was standardized: a vigorous scrub with antiseptic soap, followed by absorption with a sterile towel and painting with an alcohol solution of povidone-iodine 10% or chlorhexidine 0.5% and allowed to dry for 2 minutes. Quantitative skin cultures were obtained from the operative field before scrub, at 2 minutes after painting with antiseptic alcoholic solution, and at the end of surgery. Samples were plated on hypertonic mannitol agar, selective for staphylococci; on blood agar, to identify hemolytic colonies; and on Sabouraud agar and on eosin-methylene blue agar, selective for fungi and enterobacteria, respectively. Staphylococci were identified as coagulase-negative Staphylococcus species or Staphylococcus aureus on the basis of coagulase testing. Patients were followed up for 30 days to determine postoperative infection. Centers for Disease Control and Prevention definitions and classification of surgical-site infections were adopted.4Table 1 shows the comparisons between the groups before antisepsis, after 2 minutes, and at the end of surgery, regarding bacterial counts.Table 1: Colony-Forming Unit Counts in Povidone-Iodine and Chlorhexidine GroupsMean operation time was 107.9 minutes in the povidone-iodine group and 97.9 minutes in the chlorhexidine group. The correlation between duration of operation and skin colonization at the end of surgery was significant only for staphylococci, in the povidone-iodine group (p < 0.001). S. aureus was identified in 17 patients (7.2 percent): 10 patients in the povidone-iodine group and seven in the chlorhexidine group (p = 0.61), only before antisepsis. Four patients (1.6 percent) developed postoperative infection. All of them were allocated to the povidone-iodine group (p = 0.06). The infections, in all cases, were classified as superficial incisional surgical-site infections.4 Chlorhexidine was significantly more effective than povidone-iodine in reducing the colony counts of coagulase-negative staphylococci at the end of surgery. The superiority of chlorhexidine has several potential explanations. In contrast to iodine-containing compounds, chlorhexidine is not neutralized by contact with blood or other protein-rich biomaterials and has a more prolonged bactericidal action.5 The ultimate measure of effectiveness of any skin preparation technique is its ability to prevent postoperative infections.2 Despite the fact that all patients with postoperative infection were from the povidone-iodine group, no statistically significant difference in postoperative infection rates was found. However, because staphylococcal skin colonization was significantly lower at the end of surgery when chlorhexidine 0.5% antisepsis was used, we conclude that it is a better choice for skin antisepsis before elective clean plastic surgery procedures. Daniela F. Veiga, M.D., Ph.D. Division of Plastic Surgery Department of Surgery Universidade do Vale do Sapucaí Division of Plastic Surgery Department of Surgery Universidade Federal de São Paulo Carlos A. V. Damasceno, Ph.D. Department of Microbiology Universidade do Vale do Sapucaí Joel Veiga-Filho, M.D. Ricardo G. Figueiras, M.D. Roberto B. Vieira, M.D. Division of Plastic Surgery Department of Surgery Universidade do Vale do Sapucaí Fábio H. Florenzano, Ph.D. Department of Biochemistry Universidade do Vale do Sapucaí Yara Juliano, Ph.D. Department of Bioestatistics Universidade do Vale do Sapucaí Pouso Alegre, Brazil Universidade Federal de São Paulo Lydia M. Ferreira, M.D., Ph.D. Division of Plastic Surgery Department of Surgery Universidade Federal de São Paulo São Paulo, Brazil