Effectiveness of vaginal douching on febrile and infectious morbidities after total abdominal hysterectomy: a multicenter randomized controlled trial.

Objective: To evaluate the effectiveness of vaginal douching with 1 per cent povidone-iodine in reducing febrile and infectious morbidities after total abdominal hysterectomy (TAH).
Method: The authors conducted a randomized controlled trial in 300 patients undergoing elective TAH in three hospitals in Northeast Thailand: a university, a regional and a general hospital. The patients were randomly allocated to the intervention or control groups. Patients in the intervention group received pre-operative vaginal douching with 1 per cent povidone-iodine while patients in the control group did not. External evaluators not apprised of the intervention assessed febrile and infectious morbidities.
Results: 300 patients were enrolled in the study. The incidences of febrile morbidity in patients with and without pre-operative vaginal douching were 25 and 35 per cent, respectively, though not statistically significant (risk difference -9.6%, 95% CI -19.9%, 0.8%, adjusted odds ratio 0.6, 95% CI 0.3%, 1.0%). A statistically significant difference in infectious morbidity was found between the groups (8 vs 19%, risk difference -10.0%, 95% CI -17.8%, -2.2%, adjusted odds ratio 0.4, 95% CI 0.2%, 0.9%).
Conclusion: Pre-operative vaginal douching with 1 per cent povidone-iodine significantly reduces infectious morbidities after TAH.