Povidone iodine noninferior to chlorhexidine gluconate for preoperative skin antisepsis

Editor's Note

Amid continued debate about the best choice of preoperative skin antiseptic, findings published in JAMA June 17 show that povidone iodine in alcohol offers similar outcomes to chlorhexidine gluconate when used in alcohol.

The randomized clinical trial included 3,360 patients in 3 tertiary care hospitals in Switzerland, 2,187 of whom underwent cardiac surgery and 1,173 of whom underwent abdominal surgery. Each month for 18 months, study sites were randomly assigned to use either povidone iodine or chlorhexidine gluconate in alcohol as a preoperative skin antisepsis for preventing surgical site infections (SSIs).

Of the total, 1,598 patients (26 cluster periods) were randomly assigned to receive povidone iodine, while 1,762 patients (26 cluster periods) received chlorhexidine gluconate. SSIs were identified in 80 patients (5.1%) in the povidone iodine group vs 97 (5.5%) in the chlorhexidine gluconate group. The difference of 0.4% “met the predefined noninferiority margin of an absolute difference of 2.5%,” researchers report.