Document Type

Article

Publication Date

2025

Abstract

Introduction: Surgical site infections (SSI) remain a prominent complication of gynecologic procedures. The only FDA approved compound for preoperative vaginal preparation is povidone-iodine. Direct comparison of commonly used agents is needed to inform appropriate standards of care. The objective of this study is to compare the effectiveness of 10% povidone-iodine (PI), 4% chlorhexidine gluconate (CHG), baby shampoo (BS), and 3% para-chloro-meta-xylenol (PCMX) preparations for reducing bacterial and fungal colony counts and minimizing postoperative irritation after vaginal surgery. Materials and Methods: This is a single-blind, RCT conducted between 2018 and 2023 in patients 18 years or older who were undergoing surgeries requiring vaginal preparation. Patients were assigned to one of four vaginal preparation solutions on the day of surgery. Bacterial/fungal colony counts were assessed by performing pre-scrub, post-scrub, and postprocedural vaginal swabs using a standardized procedure. The primary outcome was the percentage of cases with positive cultures (bacterial count ≥ 5000 CFU/mL) for each preparation. Secondary outcomes were vaginal irritation rating by patients up to 4 weeks post-procedure and signs of infection noted by physicians. Results: Thirty-one patients completed the study. Groups were similar for percent of positive cultures at pre-scrub (PI=100%, BS=75%, CHG=100%, PCMX=83%). Baby Shampoo had higher percent of anaerobic positive cultures compared to PI at post-scrub (PI=11% vs BS=63%; p=.05), while CHG and PCMX were not different from iodine (PI=11%, CHG=50%, PCMX=0%). Groups did not differ at post-procedure (PI=20%, BS=50%, CHG=13%, PCMX=0%). There were no differences for vaginal irritation or infection scores at two days, two weeks, or one month post-procedure. Conclusions: Only BS was higher for positive cultures at the post-swab collection, although this finding should be interpreted with caution due to our small sample size. This study lends some support for the use of CHG and PCMX for the preparation of the vagina and perineum, showing reduction in colony counts and low rates of irritation and signs of infection. Further research is needed with larger sample sizes to support these findings and to determine absolute risks of vaginal cuff cellulitis and other postoperative infection complications.


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