Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial
Journal Publication ResearchOnline@JCUAbstract
Background: Preoperative skin antisepsisis routine practice. We compared alcoholic chlorhexidine with aqueous chlorhexidine for skin antisepsis to prevent surgical site infection after minor skin excisions in general practice. Methods: We conducted this prospective, multicentre, randomized controlled trial in 4 private general practices in North Queensland, Australia, from October2015 to August 2016. Consecutive adult patients presenting for minor skin excisions were randomly assigned to undergo preoperative skin antisepsis with 0.5% chlorhexidine in 70% ethanol(intervention) or 0.5% chlorhexidineaqueous solution (control). Our primary outcome was surgical site infection within 30 days of excision. We also measured the incidence of adverse reactions. Results: A total of 916 patients were included in the study: 454 underwent antisepsis with alcoholic chlorhexidine and 462 with aqueous chlorhexidine. Of these, 909 completed follow-up. In the intention-to-treat analysis of cases available at follow-up, there was no significant difference in the incidence of surgical site infection between the alcoholic chlorhexidine arm (5.8%, 95% confidence interval [CI] 3.6% to 7.9%) and the aqueous chlorhexidine arm (6.8%,95% CI 4.5% to 9.1%). The attributable risk reduction was 0.010 (95% CI –0.021to 0.042), the relative risk was 0.85 (95%CI 0.51 to 1.41), and the number needed to treat to benefit was 100. Per protocol and sensitivity analyses produced similar results. The incidence of adverse reactions was low, with no difference between groups (p = 0.6). Interpretation: There was no significant difference in efficacy between alcoholic and aqueous chlorhexidine for the prevention of surgical site infection after minor skin excisions in general practice. Trial registration: https://www.anzctr.org.au, no. ACTRN12615001045505
Journal
Canadian Medical Association Journal
Publication Name
N/A
Volume
189
ISBN/ISSN
1488-2329
Edition
N/A
Issue
31
Pages Count
9
Location
N/A
Publisher
Canadian Medical Association
Publisher Url
N/A
Publisher Location
N/A
Publish Date
N/A
Url
N/A
Date
N/A
EISSN
N/A
DOI
10.1503/cmaj.161460