Olanexidine may be superior in reducing the occurrence of surgical site infection (SSI) after clean-contaminated surgery compared to aqueous povidone-iodine, according to a study published in Lancet Infectious Diseases.

Current guidelines to reduce SSI have indicated the efficacy of some antiseptics such as chlorhexidine-alcohol and povidone-iodine, but the optimal recommendation has not been established. This multicenter, prospective, randomized controlled, blinded-endpoint superiority trial conducted within 4 facilities in Japan compared the effect of aqueous olanexidine and aqueous povidone-iodine on the incidence of SSI following clean-contaminated surgery.

In total, 587 patients who underwent elective clean-contaminated wound surgery were included; investigators randomly assigned patients to surgical antisepsis with either an aqueous formulation of 1.5% olanexidine (n=294) or aqueous formulation of 10% povidone-iodine (n=293). Olanexidine was used in a ready-to-use applicator and povidone-iodine was administered by a brush or by compression using pliers. Antiseptics were applied from the papilla with a cranial limit and to the upper thigh with a caudal limit.

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The primary outcome of this study was 30-day SSI in the intention-to-treat population. The surgical wound site of each patient was observed daily, and all patients underwent at least 1 outpatient visit within 30 days post-surgery after discharge.

The study was limited due to its inclusion of surgeries with varying SSI rates. However, this allows data to better reflect real-world clinical practice, the authors noted.

Results showed that olanexidine significantly reduced the occurrence of overall SSI and superficial incisional SSI in clean-contaminated surgery when compared to aqueous povidone-iodine. The primary outcome of 30-day SSI occurred in 19 patients (7%) in the olanexidine group and 39 patients (13.3%) in the povidone-iodine group (adjusted risk ratio, 0.48; 90% CI, 0.30-0.74; P =.002).

“Our results will contribute to surgical site infection management for patients who undergo many types of clean-contaminated surgeries by providing new SSI prevention procedures and potentially reducing medical costs,” study authors concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Obara H, Takeuchi M, Kawakubo H, et al. Aqueous olanexidine versus aqueous povidone-iodine for surgical skin antisepsis on the incidence of surgical site infections after clean-contaminated surgery: a multicentre, prospective, blinded-endpoint, randomized controlled trial. Lancet Infect Dis. 2020;20(11):1281-1289. DOI: 10.1016/S1473-3099(20)30225-5.

This article originally appeared on Infectious Disease Advisor