Chlorhexidine Versus Iodine for Vaginal Preparation Before Hysterectomy: A Randomized Clinical Trial.

Abstract

OBJECTIVE:

The American College of Obstetricians and Gynecologists does not provide a recommendation regarding the preferred vaginal preparation solution. We intended to compare the effectiveness of chlorhexidine versus iodine in decreasing vaginal bacterial counts.

METHODS:

In this institutional review board-approved study, participants undergoing total hysterectomy via vaginal or laparoscopic approach were randomized to 4% chlorhexidine or 10% iodine for presurgical vaginal preparation. Swabs were collected from the vaginal mucosa before, then 30, 60, and 90 minutes after preparation. Our primary outcome was the number of positive cultures (≥5,000 bacteria) at 90 minutes. The secondary outcomes included the presence of selected pathogens, postoperative complications, and infections. The sample size of 71 per arm was calculated using ɑP = 0.05, 80% power, and anticipating a 22% difference in positive cultures.

RESULTS:

Between May 2018 and August 2019, 85 participants were randomized. The average age was 59.8 years (SD, 11.4), and the median Charlson Comorbidity Index score was 2 (minimum, 0; maximum, 6). Baseline bacterial counts were similar in both groups. Chlorhexidine demonstrated a lower percentage of positive cultures at 90 minutes (47.6% vs 85.4%; odds ratio, 10.6; P = 0.001). In addition, the median bacterial count in the chlorhexidine group was significantly lower than the iodine group (3,000 vs 24,000 colony-forming units, P < 0.001) at 90 minutes. No surgical site infections were identified in either group during the 30-day postoperative period, and there were no reported adverse reactions to either solution.

CONCLUSIONS:

Chlorhexidine resulted in substantially lower bacterial counts after preparation compared with iodine. Gynecologic surgeons may consider switching to 4% chlorhexidine for vaginal preparation before hysterectomy.

• Authors: Austin M Hill, Rachel N Pauls, Jack Basil, Tiffanie Tam, Eunsun Yook, Abigail Shatkin-Margolis, Steven Kleeman, Jennifer Yeung, Emily Aldrich, Catrina C Crisp
• Journal: Female pelvic medicine & reconstructive surgery (Female Pelvic Med Reconstr Surg) Vol. 28 Issue 2 Pg. 77-84 (02 01 2022) ISSN: 2154-4212 [Electronic] United States
• PMID: 34333502 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 American Urogynecologic Society. All rights reserved.

Chemical References

• Anti-Infective Agents, Local
• Povidone-Iodine
• Iodine
• Chlorhexidine

Topics

• Anti-Infective Agents, Local
• Chlorhexidine
• Female
• Humans
• Hysterectomy (adverse effects)
• Iodine
• Middle Aged
• Povidone-Iodine
• Surgical Wound Infection (prevention & control)