Minimizing Wound Contamination in a ‘Clean’ Surgery: Comparison of Chlorhexidine-Ethanol and Povidone-Iodine

<i>Purpose:</i> There is limited work analyzing the efficacy of different antiseptics in reducing wound contamination by the skin flora during hernia repair and its influence on the incidence of wound infection, which continues to be a major problem in the developing world. This study was designed to test if chlorhexidine-ethanol has superior antimicrobial efficacy compared with povidone-iodine. <i>Methods:</i> In a prospective randomized trial, the efficacy of chlorhexidine-ethanol and povidone-iodine in the reduction of colony counts of the skin flora and the incidence of surgical site infection was compared. <i>Results:</i> Both povidone-iodine and chlorhexidine-ethanol produced significant reduction in the skin bacterial colony counts, from 18.66 × 10² to 2.34 × 10² colony-forming units with povidone-iodine (59%) and from 12.34 × 10² to 0.93 × 10² colony-forming units (82%) with chlorhexidine-ethanol. Infection rates with the use of povidone-iodine and chlorhexidine-ethanol groups were not significantly different (9.5 vs. 7.0; p = 0.364). The reduction in colony counts in those who developed infection was only 15.6% compared with 77.1% in those who did not develop infection. <i>Conclusions:</i> The antibacterial efficacy of chlorhexidine-ethanol and povidone-iodine is comparable in open hernia repair.