Comparative analysis of pre operative Chlorhexidine and povidone iodine oral rinses in prevention of Surgical site infection in high-risk group oral cancer patients- A randomised clinical Trial

Abstract

Introduction

Following head and neck surgery, surgical site infections (SSIs) are a significant contributor to morbidity and mortality. Patients undergoing flap reconstruction have reported wound infection rates ranging from 20% to 40%, even with perioperative systemic antibiotic therapy. Pre-operative surgical site preparation lowers the incidence of surgical site infections (SSIs) and the microbial burden on the surgical site. Currently, the most often used preoperative skin antiseptics are povidone-iodine (PI) and chlorhexidine (CH). However, information about the frequency of mucous adverse events and the avoidance of surgical site infections (SSIs) is not consistently available. In order to lower surgical site infection in these high-risk patients undergoing head and neck surgery, our study sought to ascertain the effectiveness of preoperative topical decolonisation.

Materials and methods

This study was conducted among 60 patients of high-risk group presenting oral squamous cell carcinoma requiring surgical intervention. Our study inclusion criteria were high risk group patients having ASA III, Tumour staging IV, Undergoing flap reconstruction. Patients were randomised into three groups. Group A - No use of any pre-operative topical anti-microbial decolonization method, Group B – Chlorhexidine mouth wash, Group C – Povidone iodine rinses. Pre-operatively for 1 week with standard perioperative systemic antimicrobial prophylaxis. The main outcome was the incidence of SSIs.

Results and discussion

Out of 60 patients involved in study 20 developed surgical site infection- 10 patients of the control group, 3 patients of the CHX group, and 7 patients of the povidone-iodine group.  The results of our study indicated that the Chlorhexidine group had a significantly lower infection rate, and that topical decolonisation prior to surgery is a useful strategy for lowering surgical site incidence.

 Conclusion

The frequency of surgical site infections following head and neck surgery is greatly reduced when antiseptic mouthwashes, such as those containing 0.2% chlorhexidine and 10% povidone iodine, are used before surgery. However, occurrence of surgical site infection is multifactorial.