Background

Surgical site infections are the third most frequently reported hospital- acquired infection. Women who give birth by caesarean section are exposed to the possibility of infection from their own, and external or environmental, sources of infection. Preventing infection by properly preparing the skin before incision is thus a vital part of the overall care given to women prior to caesarean birth. An antiseptic is applied to remove or reduce bacteria. These antiseptics include iodine or povidone-iodine, alcohol, chlorhexidine and parachlorometaxylenol and can be applied as liquids or powders, scrubs, paints, swabs or on impregnated drapes.

Review question
To compare the effects of different forms and methods of preoperative skin preparation for preventing postcaesarean infection.

Main findings
The available evidence from the randomised trials identified for this review (six trials involving 1522 women) is not sufficient to guide the best type of skin preparation for preventing wound or surgery site infection following caesarean section. When comparing different antiseptic procedures, one trial of chlorhexidine gluconate compared with iodine alone was associated with lower rates of bacterial growth after caesarean section; however, the quality of evidence for this outcome was judged to be of very low quality. No difference was found in wound infection (five trials) or uterine infection including of the lining (endometritis) (two trials).

Quality of the evidence and conclusions

The six included trials studied different forms, concentrations and methods of applying skin preparations for surgery. Of the six trials, two were reasonably large and the other four involved only small numbers of women. The overall quality of the evidence for wound infection was assessed as being low to very low for the different interventions.

More high-quality research about preparation is needed for women, particularly those at higher risk of surgical site infection, such as malnourished women, women with diabetes mellitus or obesity, or those who have an established infection before caesarean section.