Chlorhexidine–Alcohol versus Povidone-Iodine–Alcohol for Surgical Site Antisepsis in Caesarean Section: A Prospective Randomized Study

Background: Caesarean section is one of the most frequently performed surgical procedures worldwide, and surgical site infections (SSIs) remain a major cause of postoperative maternal morbidity. Preoperative skin antisepsis is a key modifiable factor in SSI prevention. Although chlorhexidine–alcohol has shown superior efficacy in general surgery, evidence specific to caesarean sections in the Indian population is limited. Objective: To compare the effectiveness of chlorhexidine–alcohol versus povidone-iodine–alcohol for preoperative skin antisepsis in reducing surgical site infections following caesarean section. Methods: This prospective, randomized comparative study was conducted over 8 months at a tertiary care center in India. A total of 460 women undergoing elective or emergency caesarean section were randomized into two groups: chlorhexidine–alcohol (n = 224) and povidone-iodine–alcohol (n = 236). Standardized surgical and antibiotic protocols were followed. The primary outcome was the incidence of SSI within 30 days postoperatively, classified according to CDC criteria. Statistical analysis was performed using the chi-square test, with p < 0.05 considered significant. Results: The overall incidence of SSI was significantly lower in the chlorhexidine–alcohol group compared to the povidone-iodine–alcohol group (6.95% vs 14.28%, p = 0.005). Both superficial incisional SSIs (5.49% vs 10.10%, p = 0.03) and deep incisional SSIs (1.46% vs 4.18%, p = 0.04) were significantly reduced with chlorhexidine–alcohol. Conclusion: Chlorhexidine–alcohol is significantly more effective than povidone-iodine–alcohol in reducing both superficial and deep surgical site infections following caesarean section. Its routine use for preoperative skin preparation in obstetric surgery is recommended.