Skin preparation for preventing infection following caesarean section

TLDR: This review found that chlorhexidine gluconate compared with iodine alone was associated with lower rates of bacterial growth at 18 hours after caesarean section, and this outcome was judged as very low quality of evidence.

Abstract: Surgical site infections are the third most frequently reported hospital acquired infection. Women who give birth by caesarean section are exposed to the possibility of infection from their own, and external or environmental, sources of infection. Preventing infection by properly preparing the skin before incision is thus a vital part of the overall care given to women prior to caesarean birth. An antiseptic is applied to remove or reduce bacteria. These antiseptics include iodine or povidone-iodine, alcohol, chlorhexidine and parachlorometaxylenol and can be applied as liquids or powders, scrubs, paints, swabs or on impregnated drapes. The available evidence from the randomised trials identified for this review (five trials involving 1462 women) is not sufficient to guide the best type of skin preparation for preventing wound or surgery site infection following caesarean section. Comparing different antiseptic procedures, no difference was found in wound infection (four trials) or uterine infection including of the lining (endometritis) (two trials). The five included trials studied different forms, concentrations and methods of applying skin preparations for surgery. Of the five trials, two were reasonably large and the other three involved only small numbers of women. Guidance about preparation is needed for women, particularly those at higher risk of surgical site infection, such as malnourished women, women with diabetes mellitus or obesity, or those who have an established infection before caesarean section.