Efficacy of povidone iodine and alcohol-chlorhexidine gluconate antiseptic solutions in patients undergoing Orthopaedic Surgery

Abstract

Introduction: Surgical site infection is a well-known and relatively common complication of orthopaedic surgeries. Despite the dreaded effects, there’s no common agreed protocol at most of the Hospitals in India. Since the patient's skin is a major source of pathogens that cause surgical-site infection, proper optimization of preoperative skin antisepsis may decrease postoperative infections.Objective: To compare the effect of 10% povidone iodine and 70% ethyl alcohol-0.5% chlorhexidine gluconate antiseptic solutions on lowering bacterial load pre operatively in patients undergoing Orthopaedic Surgery at Ruby Hall Clinic.Methodology: It was a randomized controlled trial, done at Department of Orthopaedics, Ruby Hall Clinic. A total of 44 consecutive patients undergoing orthopaedic surgery in the month of March, 2019 were recruited into the study and randomized to receive one of two antiseptic solutions (10% Povidine-iodine or Chlorhexidine gluconate 0.5% with ethyl alcohol 70%). Swabs were taken from incision site and analyzed via qualitative and quantitative analysis before and after skin preparation.Results: The proportion of positive culture was significantly higher in the Povidone iodine group (28.6%) than in the Ethyl alcohol-chlorehxidine gluconate group (4.5%) (p=0.035). 70% Ethyl-Alcohol-0.5% chlorhexidine gluconate solution is more effective than 10% Povidone iodine in Ankle region (p-0.013). Age, sex, type of ward (Private, Semi Private or General) and the duration of hospital stay do not influence efficacy of either 10% Povidone iodine or 70% Ethyl-alcohol-0.5% chlorhexidine gluconate solutions.Conclusion: We suggest that alcohol-based formulation (Eg 0.5% chlorhexidine gluconate-70% ethyl alcohol) be used for skin preparation in Orthopaedic surgery as it is superior to Povidone Iodine.