Which Antiseptic Is Best at Preventing Postoperative Infections?

Albert B. Lowenfels, MD


May 06, 2014

Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report From the Washington State Surgical Care and Outcomes Assessment Program

Hakkarainen TW, Dellinger EP, Evans HL, et al; Surgical Care and Outcomes Assessment Program Collaborative
J Am Coll Surg. 2014;218:336-344


What is the best skin preparation for the prevention of postoperative wound infection? The authors studied this problem using stored data from 7669 patients with mostly clean-contaminated procedures treated in various hospitals in the state of Washington. Four different skin antiseptic agents were compared: chlorhexidine with and without isopropyl alcohol, povidone, and povacrylex-iodine in isopropyl alcohol. The observed incidence of wound infections was similar in all 3 groups, as was the risk-adjusted rate.


Surgeons have sought methods to reduce the frequency of wound infections since the mid-19th century when Lister reported effective results from using a carbolic acid spray. This current report is one of many recent studies addressing the problem. It was not a randomized trial, so we do not know all of the patient variables, such as use and timing of preoperative antibiotics, that might have had an impact on the outcome. Furthermore, because the study was based on hospital records, there was no way to trace the development of postoperative infections after discharge. Nevertheless, the results imply that the frequencies of wound infection are similar with the various methods of skin preparation and that consideration should be given to factors such as cost. The findings resemble a recent Cochrane review[1] that found little difference in wound infection after different methods of antisepsis and concluded that factors such as cost and side effects should be considered.