RT Journal Article
SR Electronic
T1 Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1008
OP E1016
DO 10.1503/cmaj.161460
VO 189
IS 31
A1 Charles, Daniel
A1 Heal, Clare F.
A1 Delpachitra, Meth
A1 Wohlfahrt, Michael
A1 Kimber, Debbie
A1 Sullivan, Julie
A1 Browning, Sheldon
A1 Saednia, Sabine
A1 Hardy, Alexandra
A1 Banks, Jennifer
A1 Buttner, Petra
YR 2017
UL http://www.cmaj.ca/content/189/31/E1008.abstract
AB BACKGROUND: Preoperative skin antisepsis is 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 October 2015 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% chlorhexidine aqueous 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 –0.021 to 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