{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:17:10Z","timestamp":1793373430458,"version":"4.5.0"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,8,20]]},"abstract":"\n Importance<\/jats:title>\n Preoperative skin antisepsis is an established procedure to prevent surgical site infections (SSIs). The choice of antiseptic agent, povidone iodine or chlorhexidine gluconate, remains debated.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether povidone iodine in alcohol is noninferior to chlorhexidine gluconate in alcohol to prevent SSIs after cardiac or abdominal surgery.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Multicenter, cluster-randomized, investigator-masked, crossover, noninferiority trial; 4403 patients undergoing cardiac or abdominal surgery in 3 tertiary care hospitals in Switzerland between September 2018 and March 2020 were assessed and 3360 patients were enrolled (cardiac, n\u2009=\u20092187 [65%]; abdominal, n\u2009=\u20091173 [35%]). The last follow-up was on July 1, 2020.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Over 18 consecutive months, study sites were randomly assigned each month to either use povidone iodine or chlorhexidine gluconate, each formulated in alcohol. Disinfectants and skin application processes were standardized and followed published protocols.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcome was SSI within 30 days after abdominal surgery and within 1 year after cardiac surgery, using definitions from the US Centers for Disease Control and Prevention\u2019s National Healthcare Safety Network. A noninferiority margin of 2.5% was used. Secondary outcomes included SSIs stratified by depth of infection and type of surgery.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 1598 patients (26 cluster periods) were randomly assigned to receive povidone iodine vs 1762 patients (26 cluster periods) to chlorhexidine gluconate. Mean (SD) age of patients was 65.0 years (39.0-79.0) in the povidone iodine group and 65.0 years (41.0-78.0) in the chlorhexidine gluconate group. Patients were 32.7% and 33.9% female in the povidone iodine and chlorhexidine gluconate groups, respectively. SSIs were identified in 80 patients (5.1%) in the povidone iodine group vs 97 (5.5%) in the chlorhexidine gluconate group, a difference of 0.4% (95% CI, \u22121.1% to 2.0%) with the lower limit of the CI not exceeding the predefined noninferiority margin of \u22122.5%; results were similar when corrected for clustering. The unadjusted relative risk for povidone iodine vs chlorhexidine gluconate was 0.92 (95% CI, 0.69-1.23). Nonsignificant differences were observed following stratification by type of surgical procedure. In cardiac surgery, SSIs were present in 4.2% of patients with povidone iodine vs 3.3% with chlorhexidine gluconate (relative risk, 1.26 [95% CI, 0.82-1.94]); in abdominal surgery, SSIs were present in 6.8% with povidone iodine vs 9.9% with chlorhexidine gluconate (relative risk, 0.69 [95% CI, 0.46-1.02]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Povidone iodine in alcohol as preoperative skin antisepsis was noninferior to chlorhexidine gluconate in alcohol in preventing SSIs after cardiac or abdominal surgery.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03685604<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2024.8531","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T11:34:33Z","timestamp":1718624073000},"page":"541","source":"Crossref","is-referenced-by-count":59,"title":["Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis"],"prefix":"10.1001","volume":"332","author":[{"given":"Andreas F.","family":"Widmer","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Pediatric Research Centre, University Children\u2019s Hospital Basel, Basel, Switzerland"},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan P.","family":"Kuster","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline","family":"Wolfensberger","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffi","family":"Klimke","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Sommerstein","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland"},{"name":"Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich S.","family":"Eckstein","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Basel and University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Schoenhoff","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Beldi","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery and Medicine, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian A.","family":"Gutschow","sequence":"additional","affiliation":[{"name":"Department of Visceral and Transplantation Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Marschall","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St Louis, Missouri"},{"name":"Department of Infectious Diseases, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Schweiger","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Cantonal Hospital Zug, Baar, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Jent","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"3","key":"joi240063r1","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1001\/jama.2022.24075","article-title":"Surgical site infection prevention: a review.","volume":"329","author":"Seidelman","year":"2023","journal-title":"JAMA"},{"issue":"5","key":"joi240063r2","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1017\/ice.2018.363","article-title":"Surgical site infections and the microbiome: an updated perspective.","volume":"40","author":"Wenzel","year":"2019","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"8","key":"joi240063r3","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017.","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg"},{"issue":"11","key":"joi240063r4","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1001\/jama.2019.20830","article-title":"Preventing surgical site infections: looking beyond the current guidelines.","volume":"323","author":"Fields","year":"2020","journal-title":"JAMA"},{"issue":"1","key":"joi240063r5","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jamcollsurg.2016.10.029","article-title":"American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update.","volume":"224","author":"Ban","year":"2017","journal-title":"J Am Coll Surg"},{"issue":"4","key":"joi240063r6","doi-asserted-by":"publisher","first-page":"663","DOI":"10.3390\/jcm10040663","article-title":"Randomised controlled trials of alcohol-based surgical site skin preparation for the prevention of surgical site infections: systematic review and meta-analysis.","volume":"10","author":"Peel","year":"2021","journal-title":"J Clin Med"},{"issue":"6","key":"joi240063r7","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1097\/SLA.0000000000004076","article-title":"The comparative efficacy of chlorhexidine gluconate and povidone-iodine antiseptics for the prevention of infection in clean surgery: a systematic review and network meta-analysis.","volume":"274","author":"Wade","year":"2021","journal-title":"Ann Surg"},{"issue":"8","key":"joi240063r8","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1016\/S1473-3099(22)00133-5","article-title":"Alcoholic chlorhexidine skin preparation or triclosan-coated sutures to reduce surgical site infection: a systematic review and meta-analysis of high-quality randomised controlled trials.","volume":"22","author":"Ademuyiwa","year":"2022","journal-title":"Lancet Infect Dis"},{"issue":"10312","key":"joi240063r9","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1016\/S0140-6736(21)01548-8","article-title":"Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial.","volume":"398","author":"NIHR Global Research Health Unit on Global Surgery","year":"2021","journal-title":"Lancet"},{"issue":"9","key":"joi240063r10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0044277","article-title":"The forgotten role of alcohol: a systematic review and meta-analysis of the clinical efficacy and perceived role of chlorhexidine in skin antisepsis.","volume":"7","author":"Maiwald","year":"2012","journal-title":"PLoS One"},{"issue":"10","key":"joi240063r11","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1016\/S1473-3099(17)30448-6","article-title":"WHO\u2019s recommendation for surgical skin antisepsis is premature.","volume":"17","author":"Maiwald","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"joi240063r13","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/S1473-3099(20)30738-6","article-title":"Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial.","volume":"21","author":"Guenezan","year":"2021","journal-title":"Lancet Infect Dis"},{"issue":"5","key":"joi240063r15","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1093\/cid\/ciaa1103","article-title":"Assessing the potential for unintended microbial consequences of routine chlorhexidine bathing for prevention of healthcare-associated infections.","volume":"72","author":"Babiker","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"10","key":"joi240063r16","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1016\/j.cmi.2019.06.016","article-title":"Chlorhexidine-alcohol versus iodine-alcohol for surgical site skin preparation in an elective arthroplasty (ACAISA) study: a cluster randomized controlled trial.","volume":"25","author":"Peel","year":"2019","journal-title":"Clin Microbiol Infect"},{"issue":"3","key":"joi240063r17","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1097\/SLA.0b013e3182468b2d","article-title":"No risk of surgical site infections from residual bacteria after disinfection with povidone-iodine-alcohol in 1014 cases: a prospective observational study.","volume":"255","author":"Tschudin-Sutter","year":"2012","journal-title":"Ann Surg"},{"issue":"1","key":"joi240063r18","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s13756-020-00780-z","article-title":"Are three antiseptic paints needed for safe preparation of the surgical field? a prospective cohort study with 239 patients.","volume":"9","author":"Roth","year":"2020","journal-title":"Antimicrob Resist Infect Control"},{"issue":"6","key":"joi240063r19","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1017\/ice.2017.55","article-title":"First results of the Swiss National Surgical Site Infection Surveillance Program: who seeks shall find.","volume":"38","author":"Troillet","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"10","key":"joi240063r20","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1017\/ice.2017.169","article-title":"Structure, process, and outcome quality of surgical site infection surveillance in Switzerland.","volume":"38","author":"Kuster","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"12","key":"joi240063r21","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1017\/ice.2021.14","article-title":"Surveillance quality correlates with surgical site infection rates in knee and hip arthroplasty and colorectal surgeries: a call to action to adjust reporting of SSI rates.","volume":"42","author":"Atkinson","year":"2021","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"2","key":"joi240063r22","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/S0196-6553(99)70088-X","article-title":"Guideline for prevention of surgical site infection, 1999.","volume":"27","author":"Mangram","year":"1999","journal-title":"Am J Infect Control"},{"issue":"3B","key":"joi240063r23","doi-asserted-by":"publisher","first-page":"152S","DOI":"10.1016\/0002-9343(91)90361-Z","article-title":"Surgical wound infection rates by wound class, operative procedure, and patient risk index.","volume":"91","author":"Culver","year":"1991","journal-title":"Am J Med"},{"issue":"6","key":"joi240063r24","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1097\/SLA.0b013e31816c3fec","article-title":"The timing of surgical antimicrobial prophylaxis.","volume":"247","author":"Weber","year":"2008","journal-title":"Ann Surg"},{"issue":"6","key":"joi240063r25","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1016\/S1473-3099(17)30176-7","article-title":"Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial.","volume":"17","author":"Weber","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"joi240063r26","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1089\/sur.2013.9999","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery.","volume":"14","author":"Bratzler","year":"2013","journal-title":"Surg Infect (Larchmt)"},{"issue":"7","key":"joi240063r27","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1056\/NEJMoa1511048","article-title":"A randomized trial comparing skin antiseptic agents at cesarean delivery.","volume":"374","author":"Tuuli","year":"2016","journal-title":"N Engl J Med"},{"issue":"2","key":"joi240063r28","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1055\/s-0038-1669907","article-title":"Chlorhexidine-alcohol versus povidone-iodine for skin preparation before elective cesarean section: a prospective observational study.","volume":"36","author":"Tolcher","year":"2019","journal-title":"Am J Perinatol"},{"issue":"6","key":"joi240063r29","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007462.pub5","article-title":"Skin preparation for preventing infection following caesarean section.","volume":"6","author":"Hadiati","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"joi240063r30","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1056\/NEJMoa2307679","article-title":"Skin antisepsis before surgical fixation of extremity fractures.","volume":"390","author":"Sprague","year":"2024","journal-title":"N Engl J Med"},{"issue":"2","key":"joi240063r31","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.ijpharm.2006.03.013","article-title":"Comparison of free and bound iodine and iodide species as a function of the dilution of three commercial povidone-iodine formulations and their microbicidal activity.","volume":"317","author":"Atemnkeng","year":"2006","journal-title":"Int J Pharm"},{"key":"joi240063r32","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/S0195-6701(85)80043-8","article-title":"Disinfectant properties of new povidone-iodine preparations.","volume":"6","author":"Schubert","year":"1985","journal-title":"J Hosp Infect"},{"key":"joi240063r12","volume-title":"Decontamination, Disinfection, and Sterilization. Manual of Clinical Microbiology","author":"Wendt","year":"2015","edition":"11th ed"},{"key":"joi240063r14","volume-title":"National Institute for Health and Care Excellence: Clinical Guidelines. Surgical Site Infections: Prevention and Treatment","author":"Team","year":"2019"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2820168\/jama_widmer_2024_oi_240063_1723483065.85417.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T11:06:10Z","timestamp":1724151970000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2820168"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2024,8,20]]},"references-count":32,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,8,20]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2024.8531","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2024,8,20]]}}}