To Study and Compare the Effect of Pre-Operative Skin Preparation with Aqueous Povidone Iodine Only and in Combination with Alcoholic Chlorhexidine on Surgical Site Infection in Tertiary Care Hospital SVRRGGH, Tirupati

BACKGROUND Even the normal skin of healthy humans usually harbours a rich bacterial flora, which are usually non-pathogenic. But these organisms always have a potential to cause infection of the surgical site. The aim of surgical site preparation with antiseptics is to remove microorganisms harbouring the skin surface to a lower level. Povidine iodine (iodophors) and chlorhexidine are the agents most often used for pre-operative surgical site antisepsis. In this study, we wanted to determine the efficacy of pre-operative skin preparation with aqueous povidone iodine alone and when used in combination with alcoholic chlorhexidine for surgical site asepsis. METHODS This is a cross-sectional study. 200 patients (100 in each group) were considered for the study who were undergoing clean elective surgery. Pre-operative preparation of skin in the surgical area was done by the respective antiseptic which was planned accordingly, after such application, sterile saline swab culture was taken immediately from the site of incision during surgery. In the cases which showed growth of organisms, they were isolated from colonies and subjected to gram staining, coagulase test and antibiotic sensitivity test. The organisms thus isolated were identified by their morphological and cultural characteristics and difference in colonization rates were considered as a measure of antiseptic regimen efficacy. RESULTS The results showed that, usage of povidine iodine along with alcoholic chlorhexidine is more efficacious and showed significant reduction of colonization rates at the site of incision, in comparison to using povidone iodine alone. Postoperative wound infections were lower, when povidine iodine is used in combination with chlorhexidine is used for pre-operative surgical site preparation. CONCLUSIONS Pre-operative skin preparation with the chlorhexidine gluconate 2.5 % v/v in 70 % propanol followed by aqueous povidone-iodine solution is an ideal for broad spectrum asepsis and the post-operative wound infection rate is much lower as compared to povidone iodine alone. KEYWORDS Skin Disinfection; Chlorhexidine; Propanol; Povidone-iodine; Bacterial Colonization