PREOPERATIVE SKIN PREPARATION AND INTRAOPERATIVE PELVIC IRRIGATION - IMPACT ON POSTCESAREAN ENDOMETRITIS AND WOUND-INFECTION

Objective: To determine the impact of two skin preparation methods and two techniques of pelvic irrigation on the incidence of post-cesarean endometritis and wound infection in an indigent patient population. M ethods: A randomized study was performed in 100 cesarean patients. Sub jects were assigned to one of four groups, involving either standard s kin preparation (povidone-iodine [7.5%] scrub followed by povidone-iod ine 110%] solution) or special skin preparation (5-minute scrub with p arachlorometaxylenol followed by povidone scrub and solution), and eit her normal saline or antibiotic (cefazolin sodium, 1 g in 500 mL norma l saline) irrigation of the pelvis and subcutaneous tissue at uterine and fascial closure. Four groups of patients were formed: standard ski n preparation plus normal saline irrigation, standard preparation plus antibiotic irrigation, special preparation plus normal saline irrigat ion, and special preparation plus antibiotic irrigation. Results: Endo metritis occurred significantly more often in the combined groups that did not include antibiotic irrigation than in the combined groups inv olving antibiotic irrigation (P < .001). In contrast, comparison of sk in preparation methods between povidone-iodine alone versus preparatio n including parachlorometaxylenol indicated no significant difference (P = .22). Conclusion: Skin preparation with an antibacterial scrub in addition to standard povidone-iodine scrub and solution does not appe ar to play as significant a role in the reduction of post-cesarean end ometritis or wound infection as does intraoperative pelvic irrigation with antibiotic solution.