Infection prevention in practice · 2026
Prophylactic incisional wound irrigation with aqueous chlorhexidine gluconate vs aqueous povidone iodine for prevention of surgical site infection in elective abdominal surgery.
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Bontekoning Nathan, Groenen Hannah, Hannink Gerjon, Hollmann Markus W, de Jonge Stijn W, Wolfhagen Niels, Boermeester Marja A, EPO2CH Study Group, EPOCH Study Group
Аннотация
BACKGROUND: Incisional prophylactic intra-operative wound irrigation (pIOWI) with an aqueous antiseptic solution effectively reduces surgical site infections (SSIs); however, data on the use of aqueous chlorhexidine gluconate remain limited, and no clinical comparisons with aqueous povidone iodine exist. We therefore compare the efficacy of aqueous chlorhexidine gluconate with aqueous povidone iodine for incisional pIOWI in the prevention SSI in elective abdominal surgery.
METHODS: A post hoc analysis of data from the randomised controlled Enhanced PeriOperative Care and Health (EPO2CH) trial was conducted, including 699 patients, to assess the effect of aqueous chlorhexidine gluconate compared with aqueous povidone iodine for incisional pIOWI on the incidence of SSI. Multiple imputation with chained equations was used to impute missing values. The association between the type of irrigation and SSI was assessed using inverse probability of treatment-weighted logistic regression.
FINDINGS: Weighted regression analysis showed a statistically non-significant difference in the SSI rate (-3.03%, 95% confidence interval [CI]: -7.04 to 0.98) for pIOWI with aqueous chlorhexidine gluconate (4.05%) vs aqueous povidone iodine (7.08%).
INTERPRETATION: While the SSI rate for pIOWI with aqueous chlorhexidine gluconate showed a lower estimated SSI incidence than with aqueous povidone iodine, the difference was not statistically significant, with wide CIs, indicating uncertainty. Further research is needed to assess the hypothesis that pIOWI with chlorhexidine gluconate, than in povidone iodine, may reduce SSI.
METHODS: A post hoc analysis of data from the randomised controlled Enhanced PeriOperative Care and Health (EPO2CH) trial was conducted, including 699 patients, to assess the effect of aqueous chlorhexidine gluconate compared with aqueous povidone iodine for incisional pIOWI on the incidence of SSI. Multiple imputation with chained equations was used to impute missing values. The association between the type of irrigation and SSI was assessed using inverse probability of treatment-weighted logistic regression.
FINDINGS: Weighted regression analysis showed a statistically non-significant difference in the SSI rate (-3.03%, 95% confidence interval [CI]: -7.04 to 0.98) for pIOWI with aqueous chlorhexidine gluconate (4.05%) vs aqueous povidone iodine (7.08%).
INTERPRETATION: While the SSI rate for pIOWI with aqueous chlorhexidine gluconate showed a lower estimated SSI incidence than with aqueous povidone iodine, the difference was not statistically significant, with wide CIs, indicating uncertainty. Further research is needed to assess the hypothesis that pIOWI with chlorhexidine gluconate, than in povidone iodine, may reduce SSI.