Skin preparation for preventing infection following caesarean section

source extracted confidence: high 2026-04-09
#adult #anti-infective-agents-local #bandages #cesarean-section #chlorhexidine

Skin preparation for preventing infection following caesarean section

Hadiati et al., 2012 | Cochrane Database Syst Rev | Meta Analysis

Citation

Hadiati Diah R, Hakimi Mohammad, Nurdiati Detty S. Skin preparation for preventing infection following caesarean section. Cochrane Database Syst Rev. 2012-Sep-12(9):CD007462. doi:10.1002/14651858.CD007462.pub2

Abstract

BACKGROUND: The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section than for vaginal birth. With the increase in caesarean section, it is important that the risks to the mother are minimised as far as possible. This review focuses on different forms and methods for preoperative skin preparation to prevent infection. OBJECTIVES: To compare the effects of different agent forms and methods of preoperative skin preparation for preventing postcaesarean infection. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 January 2012) and the reference lists of all included studies and review articles SELECTION CRITERIA: Randomised and quasi-randomised trials, including cluster-randomised trials, evaluating any type of preoperative skin preparation agents, forms and methods of application for caesarean section. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed all potential studies for inclusion, assessed risk of bias and extracted the data using a predesigned form. Data were checked for accuracy. MAIN RESULTS: We included five trials with a total of 1462 women. No difference was found in the primary outcomes of either wound infection or endometritis. Two trials of 1294 women, compared drape with no drape (one trial using iodine and the other using chlorhexidine) and found no significant difference in wound infection (risk ratio (RR) 1.29; 95% confidence interval (CI) 0.97 to 1.71). One trial of 79 women comparing alcohol scrub and iodophor drape with iodophor scrub without drape reported no wound infection in either group. One trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in wound infection (RR 0.33; 95% CI 0.04 to 2.99).Two trials reported endometritis, one trial comparing alcohol scrub and iodophor drape with iodophor scrub only found no significant difference (RR 1.62; 95% CI 0.29 to 9.16). The other trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in endometritis (RR 0.88; 95% CI 0.56 to 1.38). No difference was found in the secondary outcome of either length of stay or reduction of skin bacteria colony count. No trial reported other maternal outcomes, i.e. maternal mortality, repeat surgery and re-admission resulting from infection. One trial, which was only available as an abstract, investigated the effect of skin preparation on neonatal adverse events and found cord blood iodine concentration to be significantly higher in the iodine group. AUTHORS' CONCLUSIONS: Little evidence is available from the included randomised controlled trials to evaluate different agent forms, concentrations and methods of skin preparation for preventing infection following caesarean section. Therefore, it is not yet clear what sort of skin preparation may be most efficient for preventing postcaesarean wound and surgical site infection. There is a need for high-quality, properly designed randomised controlled trials with larger sample sizes in this field. High priority questions include comparing types of antiseptic (especially iodine versus chlorhexidine), the timing and duration of applying the antiseptic (especially previous night versus day of surgery, and application methods (scrubbing, swabbing and draping).

Key Findings

We included five trials with a total of 1462 women. No difference was found in the primary outcomes of either wound infection or endometritis. Two trials of 1294 women, compared drape with no drape (one trial using iodine and the other using chlorhexidine) and found no significant difference in wound infection (risk ratio (RR) 1.29; 95% confidence interval (CI) 0.97 to 1.71). One trial of 79 women comparing alcohol scrub and iodophor drape with iodophor scrub without drape reported no wound infe

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Adult
  • Anti-Infective Agents, Local
  • Bandages
  • Cesarean Section
  • Chlorhexidine
  • Endometritis
  • Ethanol
  • Female
  • Humans
  • Iodine
  • Iodophors
  • Pregnancy
  • Randomized Controlled Trials as Topic
  • Surgical Wound Infection
  • Xylenes

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review
  • Vertical: iodine

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09