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Jumping on the Bandwagon: Comparing the Efficacy of Chlorhexidine Versus Povidone-Iodine Preoperative Skin Antiseptic in Preventing Surgical Site Infections Following Pediatric Orthopaedic Surgery
- Source :
- Journal of Pediatric Orthopaedics. 42:e39-e44
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Background Adult literature has demonstrated chlorhexidine (CH) superiority at preventing surgical-site infections when compared with povidone-iodine (P-I). The purpose of this study is to compare the rate of postoperative infections after preoperative skin cleansing with either CH or P-I in pediatric orthopaedic surgery in an effort to identify superiority. Methods We retrospectively identified all patients (18 y and below) that underwent orthopaedic surgery at our institution in 2015, when P-I was the preoperative skin antisepsis of choice, and in 2018, when a change in protocol resulted in more frequent use of CH. Open fractures, infections, neuromuscular, and tumor surgeries were excluded. Orthopaedic surgeries were classified according to their subspecialty (sports-related/upper extremity, hip and lower extremity, trauma-related, or spine procedure). A 1:1 propensity score matching was conducted within each procedure group on the basis of age, sex, and year using nearest-neighbor matching. Spine procedures could not be matched and were subsequently excluded from analyses. Results Propensity score matching matched 1416 CH cases with 1416 P-I controls. The infection rate for CH was 19 infections per 1000 cases (27/1416; 1.9%) compared with an infection rate of 11 infections per 1000 cases (16/1416; 1.1%) for P-I subjects. No difference was detected in infection rate across preoperative skin antisepsis groups (P=0.12). Moreover, it was found that CH and P-I resulted in significantly equivalent infection rates to within ±1.5% (P=0.004). When stratified by procedure type, CH used in sports/upper extremity procedures resulted in 29 more infections per 1000 cases compared with P-I use (16/450; 3/450; P=0.005). No difference was detected in infection rate across CH and P-I skin antisepsis groups in lower extremity procedures (9/792; 8/792; P=1.00) or in trauma-related procedures (3/174; 4/174; P=1.00). Conclusions CH and P-I are both protective against postoperative infections after sports/upper extremity, lower extremity, and trauma-related pediatric orthopaedic procedures. P-I may provide improved protection over CH as a preoperative skin antisepsis in upper extremity and sports-related procedures. Level of evidence Level III-comparative cohort.
- Subjects :
- Adult
medicine.medical_specialty
medicine.drug_class
medicine.disease_cause
Jumping
Antiseptic
Preoperative Care
Surgical site
medicine
Humans
Surgical Wound Infection
Orthopedic Procedures
Orthopedics and Sports Medicine
Child
Povidone-Iodine
Retrospective Studies
Skin
business.industry
Chlorhexidine
General Medicine
Frequent use
Surgery
Pediatrics, Perinatology and Child Health
Propensity score matching
Orthopedic surgery
Cohort
Anti-Infective Agents, Local
business
medicine.drug
Subjects
Details
- ISSN :
- 02716798
- Volume :
- 42
- Database :
- OpenAIRE
- Journal :
- Journal of Pediatric Orthopaedics
- Accession number :
- edsair.doi.dedup.....2109fbd72004586a1c1d398d0d98b3c3