Chlorhexidine-alcohol compared with povidone-iodine for surgical-site antisepsis in cesarean deliveries

Obstet Gynecol. 2012 Nov;120(5):1037-44. doi: 10.1097/aog.0b013e31826f3bd9.


Objective: To estimate the incidence of surgical-site infection with use of chlorhexidine-alcohol compared with povidone-iodine among women undergoing cesarean deliveries.

Methods: This was a retrospective cohort review of 1,000 consecutive cases in women who underwent cesarean delivery over a 1-year interval. The primary outcome was any surgical-site infection within 30 days (Centers for Disease Control and Prevention criterion).

Results: Mean age and parity were equivalent (29.8±5.9 years; 2.6±1.4). Women were similar regarding baseline characteristics, including acknowledged surgical-site infection comorbidities (body mass index [BMI, calculated as weight (kg)/[height (m)]2], gestational diabetes, smoking; P>.05). Method of skin incision closure was different, with 91% among povidine-iodine compared with 81% among chlorhexidine-alcohol using staples (P<.001). Although the duration of surgical time was higher among chlorhexidine women (67.2 compared with 60.0 minutes; P<.001), fewer women in the chlorhexidine group were classified as having undergone an "urgent" cesarean delivery (29% compared with 46%; P<.001). Concerning surgical-site infection, the overall rate was similar between the two groups (5% [n=25] chlorhexidine and 5.8% [n=29] povidone-iodine; P=.58). In multivariable analysis and after control for potential confounders, odds for surgical-site infection remained similar between the two groups (adjusted odds ratio 0.74, 95% confidence interval 0.41-1.33; P=.32). The only significant predictor of surgical-site infection was duration of cesarean delivery, in which every 1-minute increase in duration increased the odds for infection by 1.3% (adjusted odds ratio 1.013, 95% CI 1.004-1.022; P=.004).

Conclusion: The single significant predictor of surgical-site infection is operative time. Cleansing with povidone-iodine may be a cost-effective and equally efficacious alternative to chlorhexidine-alcohol among women undergoing cesarean deliveries.

Level of evidence: II.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Antisepsis / methods*
  • Cesarean Section / adverse effects*
  • Chlorhexidine / administration & dosage*
  • Cohort Studies
  • Ethanol / administration & dosage*
  • Female
  • Humans
  • Povidone-Iodine / administration & dosage*
  • Pregnancy
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / prevention & control
  • Young Adult


  • Ethanol
  • Povidone-Iodine
  • Chlorhexidine