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Changing Skin Prep Antiseptic Combination Lowers C-section Infections

ST. LOUIS – A new study is urging hospitals to change standard skin-prep practices for cesarean sections.

With more C-sections each year in the United States than any other major surgery, the procedure carries a significant rate of infection at the incision site, according to the report appearing online in The New England Journal of Medicine to coincide with a presentation at the Society for Maternal-Fetal Medicine's Annual Meeting in Atlanta.

Based on their research, Washington University School of Medicine-led investigators suggest that, instead of prepping C-section patients with the commonly used antiseptic combination iodine-alcohol, hospitals use a chlorhexidine-alcohol combination.

"One of the biggest complications of surgery, and of C-sections in particular, is infection," explained first author Methodius G. Tuuli, MD, assistant professor of obstetrics and gynecology at Washington University School of Medicine. "For a new mother who needs to care for her baby -- which is stressful even when all things are equal -- having an infection can really impair her ability to do that.”

For the clinical trial, researchers randomly assigned 1,147 patients who underwent C-sections at Barnes-Jewish Hospital from 2011 to 2015 to receive either iodine or chlorhexidine combined with alcohol for skin prep. Results indicate that 23 of the 572 patients receiving the chlorhexidine-alcohol combination developed an infection at the surgery site within 30 days, compared to 42 of those receiving the iodine-alcohol combination.

The new study was conducted at only one hospital, but researchers emphasize that the patient population was racially diverse and that more than 60% of participants received public insurance.

In addition, study authors pointed out that the chlorhexidine-alcohol combination was superior whether the C-section was scheduled or unscheduled, whether the patient was obese, whether staples or sutures were used to close the wound and whether the patient had chronic medical conditions, including diabetes.

Improving the infection rate could have a significant effect on costs, according to the article: Surgical site infections currently complicate 5% to 12% of the 1.3 million C-sections in the United States, at an average cost of $3,500 for treatment.

“There are few circumstances when a single study should change our practice,” senior author George A. Macones, MD, said in a Washington University press release. “But based on the biological plausibility and the striking reduction in surgical-site infections with chlorhexidine, this is one of those circumstances.”