Aqueous chlorhexidine similar to alcohol-based chlorhexidine for skin decontamination before minor skin surgery

Référence

Charles D, Heal CF, Delpachitra M, et al. Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial. CMAJ 2017;189(31):E1008-E1016.

Sommaire

Previous studies have found that alcohol-based chlorhexidine is superior to povidone iodine for skin decontamination prior to surgical skin procedures. However, the alcohol can "erase" markings intended to define excision lines and landmarks, and aqueous chlorhexidine is now available. These busy rural general practitioners in Australia randomized patients who presented for a minor skin procedure to receive aqueous chlorhexidine or chlorhexidine in 70% ethanol. Allocation was concealed, and outcome assessors were masked to treatment assignment. Patients and physicians could not be masked because of the distinctive odor of the alcohol-based swabs. A total of 916 patients were randomized, and the primary outcome was skin infection within 30 days of the procedure. Patients were given standardized wound instructions, and physicians were reminded of the diagnostic criteria for infection. In the end, there was no significant difference in the likelihood of surgical site infection between the groups, 5.8% in the alcohol-based chlorhexidine group and 6.8% in the aqueous group (relative risk 0.85, 95% CI 0.51 - 1.41). Adverse reactions were minimal in both groups.