Level 2: Mid-level evidence

Preoperative skin cleansing is routinely performed to reduce the risk of surgical-site infections. A recent randomized trial suggests that cleansing with chlorhexidine-alcohol may be more effective than povidone-iodine (N Engl J Med. 2010;362:18-26). Adult patients having clean-contaminated surgery were randomized to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. Patients were followed for 30 days. Surgeries included colorectal, small intestinal, gastroesophageal, biliary, thoracic, gynecologic, or urologic procedures. In an analysis of 849 patients, the chlorhexidine-alcohol group had a lower overall rate of surgical-site infection (9.5% vs. 16.1%, P = 0.004, number needed to treat [NNT] 16), superficial incisional infection (4.2% vs. 8.6%, P = 0.008, NNT 23), and deep incisional infection (1% vs. 3%, P = 0.05, NNT 50). There were no significant differences in adverse events.