Antisepsis of the skin before spinal surgery with povidone iodine alcohol followed by chlorhexidine gluconate-alcohol versus povidone iodine-alcohol applied twice for the prevention of contamination of the wound by bacteria: a randomised controlled trial.

Sheila Patrick, Andrew McDowell, Andrew Lee, Alessandra Frau, Una Martin, Evie Gardiner, Gregory McLorinan, Niall Eames

Research output: Contribution to journalArticle


Aims:To determine if sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in spinal surgery patients. Patients and Methods: A single-centre, interventional, two arm, parallel group randomised controlled trial of 407 patients attending hospital for elective spinal surgery was conducted. For 203 patients, pre-surgical skin disinfection was by application of PVI (10% [w/w (1% w/w available iodine)] povidone iodine in 95% industrial denatured alcohol; Videne Alcoholic Tincture) twice and for 204 patients application of PVI once followed by application of CHG (2% [w/v] chlorhexadine gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint). The primary outcome measure was post-skindisinfection surgical site contamination determined by aerobic and anaerobicbacterial growth from post-skin disinfection samples. Results: The detection of viable bacteria in any one of the post-skin disinfection samples (culture-positive) was significantly lower in the group treated with both PVI and CHG than in the group treated with PVI alone: 29.1% (59) vs 41.7% (85), P=0.009; relative risk, 0.574; 95% confidence interval, 0.380 to 0.866. Conclusions: Skin antisepsis with sequential application of PVI and CHG more effectively reduces surgical wound contamination than PVI alone.
Original languageEnglish
Pages (from-to)1354-1365
Number of pages11
JournalBone and Joint Journal
Early online date1 Oct 2017
Publication statusE-pub ahead of print - 1 Oct 2017



  • Skin
  • surgery
  • wound
  • contamination
  • antiseptics
  • povidone iodine-alcohol
  • chlorhexidine gluconate-alcohol

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