Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial

Charles, Daniel, Heal, Clare, Delpachitra, Meth, Wohlfahrt, Michael, Kimber, Debbie, Sullivan, Julie, Browning, Sheldon, Saeidnia, Sabine, Hardy, Alexendra, Banks, Jennifer, and Buttner, Petra (2017) Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial. Canadian Medical Association Journal, 189 (31). E1008-E1016.

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DOI: 10.1503/cmaj.161460

View at Publisher Website: http://dx.doi.org/10.1503/cmaj.161460

Abstract

Background: Preoperative skin antisepsisis 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 October2015 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% chlorhexidineaqueous 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 –0.021to 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


Item ID:	49947
Item Type:	Article (Research - C1)
ISSN:	1488-2329
Keywords:	skin antisepsis, surgical site infection, chlorhexedine, aqueous, skin excision
Funders:	Royal Australian College of General Practitioners (RACGP), Mackay Private Practitioners Fund, James Cook University
Projects and Grants:	RACGP PWH Grieve Award, RACGP Family Medical Care Education and Research Grant
Date Deposited:	25 Aug 2017 02:37
FoR Codes:	42 HEALTH SCIENCES > 4203 Health services and systems > 420319 Primary health care @ 70% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320226 Surgery @ 20% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320205 Dermatology @ 10%
SEO Codes:	92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920412 Preventive Medicine @ 70% 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures @ 20% 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920117 Skin and Related Disorders @ 10%
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