Anjanappa T. H1, Arjun A2

BACKGROUND AND OBJECTIVE: It is an established fact now that the normal skin of healthy human beings harbours a rich bacterial flora. Normally considered nonpathogenic, these organisms way be a potential source of infection of the surgical wound. Approximately 20% of the resident flora is beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Povidone iodine (Iodophors) and chlorhexidine are most often used antiseptics for pre-operative skin preparation.

OBJECTIVES: To evaluate the efficacy of povidone iodine alone and in combination with antiseptic agent containing alcoholic chlorhexidine in preoperative skin preparation by taking swab culture. (2) To compare the rate of postoperative wound infection in both the groups.

METHODS: One hundred patients (fifty in each group) undergoing clean elective surgery with no focus of infection on the body were included in the study. The pre-operative skin preparation in each group is done with the respective antiseptic regimen. In both the groups after application of antiseptics, sterile saline swab culture was taken immediately from site of incision. In cases which showed growth of organisms, the bacteria isolated were identified by their morphological and cultural characteristics. Grams staining, coagulase test and antibiotic sensitivity test were done wherever necessary and difference in colonization rates was determined as a measure of efficacy of antiseptic regimen.

RESULTS: The results of the study showed that when compared to povidone iodine alone, using a combination of povidone iodine and alcoholic solution of chlorhexidine, the colonization rates of the site of incision were reduced significantly. As for the rate of post-operative wound infection, it is also proven that wound infections are also less if the pre-operative skin preparation is done with combination of povidone iodine and alcoholic solution of chlorhexidine as compared to povidone iodine alone.

INTERPRETATION AND CONCLUSION: Preoperative skin preparation with chlorhexidine gluconate 2.5% v/v in 70% propanol followed by aqueous povidone-iodine is an ideal regime as it has a broader antimicrobial spectrum and the rate of post-operative wound infections is much lower as compared to povidone iodine alone