OBJECTIVE: The general objective of this study was to compare the efficacy of chlorhexidine and povidone iodine for cleansing the operative field for abdominal deliveries and exploratory laparotomy for ectopic pregnancy. The specific objective was to compare the incidence of fever and surgical site infection (551) between the povidone iodine group and chlorhexidine group.

STUDY DESIGN: This is a randomized controlled trial comparing 0.2% chlorhexidine digluconate and povidone iodine 7.5% scrub followed by 10% povidone iodine paint as surgical site antiseptics. Primary outcome measured were postoperative fever and surgical site infection (551). The wounds were inspected 1, 2, 3, 7 and 14 days postoperatively. The agent used during the pre-operative antisepsis was continued during the postoperative wound dressing.

RESULTS: A total of 552 patients were enrolled between March and August 2008. There were no differences between the povidone iodine (n=277) and chlorhexidine (n=275) groups with respect to age, gravidity, distribution of cases, presence of previous cesarean section/s, past medical history, presence of co-morbid illness, smoking and alcohol use, 8MI, number of internal examinations, length of labor, length of rupture of bag of waters, type of surgery, amount of adhesions, length of operation, amount of intraoperative blood loss, use of prophylactic antibiotic, presence of break in asepsis, year level of surgeons, pre- and postoperative anemia and leukocytosis. The only variable observed to be significantly different was place of operation with 92.4% of operation being performed at the 08 Admitting Section among the chlorhexidine group (vs 84.5% in povidone iodine group). Results on the analysis of intent to treat data were comparable with that of complete data. There was no significant difference in the incidence of fever on 3, 7 and 14 days postoperatively between the povidone iodine group and chlorhexidine group. Likewise, there was no significant difference in the incidence of surgical site infection on 3 and 14 days postoperatively between the two study groups. However, there was a significant difference in the incidence of 5517 days postoperatively, occurring in 7.63% and 2.75% under the complete data (P=.0132), 6.9% and 2.6% under the positive outcome assumption (P=.0168), and in 16.6% and 7.6% under the negative outcome assumption (P=.0013) for povidone iodine and chlorhexidine group, respectively.

CONCLUSION: It appears that chlorhexidine is superior to povidone iodine in the control of surgical site infection 7 days after abdominal delivery and exploratory laparotomy for ectopic pregnancy.