Comparing postcesarean infectious complication rates using two different skin preparations.

OBJECTIVE To estimate whether a new preoperative skin preparation protocol decreases postcesarean delivery infectious complications. METHODS We performed a retrospective cohort study. A povidone-iodine (13%) scrub followed by povidone-iodine (10%) paint (SCRUB+PAINT) protocol was compared with standard paint alone (PAINT). Patients and outcomes were identified using diagnosis-related group and International Classification of Diseases, 9th Revision, Clinical Modification coding. Monthly infection rates before the new protocol (October 1, 2007-September 30, 2008) were compared with rates after the protocol (January 1, 2009-December 31, 2009). The primary and secondary outcomes were major puerperal infection and a composite of major puerperal infection and infectious wound complications. Poisson regression was used to model monthly infection rates over time while controlling for confounders known to contribute to infectious risk. RESULTS Data from 2,143 patients (PAINT: n=1,139; SCRUB+PAINT: n=1,004) were included in the analysis. There was no significant secular trend of decreasing infections over time before initiating SCRUB+PAINT (P=.42). SCRUB+PAINT was associated with a decrease in major puerperal infection (3.4 compared with 5.4/100 cesarean deliveries, P=.03) and composite wound infection (5.5 compared with 7.8/100 cesarean deliveries, P=.03) compared with PAINT alone. SCRUB+PAINT resulted in a 38% reduction in major puerperal infection (incident rate ratio 0.62 [0.42-0.93], P=.02) and a 31% reduction in composite wound infection (incident rate ratio 0.69 [0.50-0.96], P=.03) after controlling for confounders and fluctuations in the rates over time. CONCLUSION The SCRUB+PAINT protocol is associated with a decrease in the rate of postcesarean delivery infectious complications compared with using povidone-iodine topical paint alone.