A total of 270 women, all except 1 undergoing episiotomy and episiorrhaphy during vaginal delivery from June 17, 2005 until July 27, 2005 at the Philippine General Hospital, were randomly assigned to use either Chlorhexidine Digluconate, Povidone-lodine or Lactic Acid as antiseptic genital wash during and after the surgical procedure. All participants were asked to come back 1, 2, 4 and 6 weeks after discharge. Assessment was done comparing the efficacy, acceptability and safety of the three antiseptic solutions in preventing surgical site infection. Details of the surgical procedure that might have affected outcomes were also investigated. The results showed that all three antiseptic solutions were rated moderately to extremely acceptable by most of the participants. All three antiseptic solutions were equally safe. Adverse events were rare, mild and self limited. The three serious adverse events in the study were related to the pregnancy of the participants and not to the antiseptic solutions. Details of the surgical procedure that are not comparable among the 3 groups and thus seem to influence outcomes are the level of expertise of the surgeon, breaks in asepsis and severity of the accidental lacerations in the operative site. However, data on the eight participants who developed SSI did not confirm this-all these 8 cases were operated on by residents, did not have break in asepsis, and only one had laceration and the depth was reported to be subcutaneous. The duration of the operation, the amount of estimated blood loss, the type and amount of sutures used and the specific place where the surgery was performed are similar in the three groups. It appeared that oral systemic antimicrobials traditionally and commonly used for patients undergoing episiotomy and episiorrhaphy were unnecessary, and that generally good outcomes in terms of preventing surgical site infections can be obtained with the use of topical antiseptic solutions alone. Finally, compared to Povidone Iodine, and more so with lactic acid, the number of surgical site infections was found to be least in participants who used Chlorhexidine digluconate as antiseptic genital wash during and after the surgical operation. (Author)

Chlorhexidine ; Episiotomy ; Povidone-iodine ; Lactic Acid ; Anti-infective Agents, Local ; Women