***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Since the patient 's skin is a major source of pathogens that cause surgical-site infection , optimization of preoperative skin antisepsis may decrease postoperative infections . We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine . METHODS We r and omly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint . The primary outcome was any surgical-site infection within 30 days after surgery . Secondary outcomes included individual types of surgical-site infections . RESULTS A total of 849 subjects ( 409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group ) qualified for the intention-to-treat analysis . The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group ( 9.5 % vs. 16.1 % ; P=0.004 ; relative risk , 0.59 ; 95 % confidence interval , 0.41 to 0.85 ) . Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections ( 4.2 % vs. 8.6 % , P=0.008 ) and deep incisional infections ( 1 % vs. 3 % , P=0.05 ) but not against organ-space infections ( 4.4 % vs. 4.5 % ) . Similar results were observed in the per- protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period . Adverse events were similar in the two study groups . CONCLUSIONS Preoperative cleansing of the patient 's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery . ( Clinical Trials.gov number , NCT00290290 . Forty-five patients undergoing clean elective inguinal surgery were r and omly allocated to receive one of three skin preparations , ( 1 ) alcoholic povidone-iodine ( ' Betadine ' ) alone , ( 2 ) the same covered with an incise drape ( ' Steri-Drape ' ) , or ( 3 ) an iodine-containing incise drape ( ' Ioban ' ) alone . The first two preparations were superior in reducing bacterial colony counts measured on skin with cotton swabs and impression cultures . There were no clinical postoperative wound infections in any group but it is suggested that although the use of an iodine-containing incise drape alone is attractive , its bactericidal action is inferior to conventional preparations Abstract Povidone-iodine and chlorhexidine surgical scrub and skin preparation solutions were assessed by comparing postoperative wound infection rates in a prospect i ve , r and omized study of 866 patients .  The frequency of wound infection overall , as agreed by two observers , was 14·8 per cent in the povidone-iodine group and 9·7 per cent in the chlorhexidine group ( P = 0·03 ) at the time of patients ' discharge from hospital . The difference between the compounds was not significant at a ‘ st and ard ' observation period of three to four days after operation . There were significantly fewer infections with chlorhexidine than with povidone-iodine in operations on the biliary tract and in ‘ clean ' non-abdominal operations , but there were more infections ( not significantly so ) with chlorhexidine than with povidoneiodine in large bowel surgery , other laparotomies and in operations on hernia , genitalia and varicose veins . The differences in bacterial isolates from wounds tended to follow the above patterns . We conclude that , on the evidence of this study , there is no overwhelming case for using one compound rather than the other as an all- purpose preparation and scrub Purpose To determine the efficacy of 10 % povidone iodine ( PVI ) drops given before cataract extraction in addition to routine irrigation of the conjunctival sac with 1 % PVI . Methods This prospect i ve , r and omized , single-center study at the Department of Ophthalmology , Ludwig-Maximilians-University , Munich , includes 263 eyes of 242 patients undergoing cataract surgery . Patients were r and omized to receive 3 drops of 10 % PVI into the conjunctival sac ( study group ) or no PVI drops ( control group ) . All patients underwent periorbital disinfection with 10 % PVI followed by irrigation of the conjunctiva with 10 mL of 1 % PVI . Specimens were obtained prior to the application of PVI , after antibiotic administration ( T1 ) , after irrigation with PVI but before surgery ( T2 ) , and at the conclusion of surgery ( T3 ) . Results After PVI disinfection , the number of positive cultures was significantly reduced in all groups ( p<0.0001 ) from 69%-93 % at T1 to 1%-16 % at T3 . In out patients , the study group showed significantly fewer positive cultures at the conclusion of surgery compared to the control group ( 4 % vs 16 % ; p=0.03 ) . Also in in patients significant fewer positive cultures were found in the study group compared to the control group at T2 ( 12 % vs 28 % ; p=0.03 ) and at T3 ( 1 % vs 10 % ; p=0.03 ) . Conclusions Three additional drops of 10 % PVI prior to surgery provided additional benefit by reducing the conjunctival bacterial contamination rate even in the setting of preoperative irrigation of the conjunctiva with 1 % PVI Nurses at a large southwestern hospital undertook an initiative to optimize the preoperative skin preparation of patients undergoing open heart surgery .  After an extensive review of the literature , a proposal was su bmi tted to and accepted by the surgeons and internal review board of the hospital . High-risk patients were identified before surgery and r and omized into groups to receive one of four different skin preps . The incidence of infection was lower in the two groups of patients who were prepped with insoluble iodine , indicating that the type of surgical skin prep could affect whether patients develop surgical site infections . The clinical practice of skin preparation in this hospital changed based on the results Objective To compare the effect of two strategies ( enhanced h and hygiene vs meticillin-resistant Staphylococcus aureus ( MRSA ) screening and decolonisation ) alone and in combination on  MRSA rates in surgical wards . Design Prospect i ve , controlled , interventional cohort study , with 6-month baseline , 12-month intervention and 6-month washout phases . Setting 33 surgical wards of 10 hospitals in nine countries in Europe and Israel . Participants All patients admitted to the enrolled wards for more than 24 h. Interventions The two strategies compared were ( 1 ) enhanced h and hygiene promotion and ( 2 ) universal MRSA screening with contact pre caution s and decolonisation ( intranasal mupirocin and chlorhexidine bathing ) of MRSA carriers . Four hospitals were assigned to each intervention and two hospitals combined both strategies , using targeted MRSA screening . Outcome measures Monthly rates of MRSA clinical cultures per 100 susceptible patients ( primary outcome ) and MRSA infections per 100 admissions ( secondary outcome ) . Planned subgroup analysis for clean surgery wards was performed . Results After adjusting for clustering and potential confounders , neither strategy when used alone was associated with significant changes in MRSA rates . Combining both strategies was associated with a reduction in the rate of MRSA clinical cultures of 12 % per month ( adjusted incidence rate ratios ( aIRR ) 0.88 , 95 % CI 0.79 to 0.98 ) . In clean surgery wards , strategy 2 ( MRSA screening , contact pre caution s and decolonisation ) was associated with decreasing rates of MRSA clinical cultures ( 15 % monthly decrease , aIRR 0.85 , 95 % CI 0.74 to 0.97 ) and MRSA infections ( 17 % monthly decrease , aIRR 0.83 , 95 % CI 0.69 to 0.99 ) . Conclusions In surgical wards with relatively low MRSA prevalence , a combination of enhanced st and ard and MRSA-specific infection control approaches was required to reduce MRSA rates . Implementation of single interventions was not effective , except in clean surgery wards where MRSA screening coupled with contact pre caution s and decolonisation was associated with significant reductions in MRSA clinical culture and infection rates . Trial registration clinical trials.gov identifier : A prospect i ve r and omised trial was carried out to compare the efficacy of method of scrubbing the operative site for ten minutes with an antiseptic  ( GpA ; n = 68 ) with a simplified method where the antiseptic was merely painted onto the operation site  ( GpB ; n = 67 ) . The median age , sex distribution and the types of procedures done in each group were similar as was the antibiotic policy . There were a total of 11 patients who got infected , 6 in the group A and 5 in the group B. No significant difference could be demonstrated in the infection rates between the two groups . It is concluded that the old method of prolonged scrubbing the operation site can safely be omitted to a more simplified version OBJECTIVE The purpose of this study was to compare the efficacy of chlorhexidine and povidone iodine for cleansing the operative field for vaginal surgery . STUDY DESIGN This was a r and omized controlled trial that compared 10 % povidone iodine and 4 % chlorhexidine gluconate as surgical scrubs . Our primary end point was the proportion of contaminated specimens ( defined as total bacterial colony counts of > /=5000 colony-forming units ) per group found throughout the surgical procedures . All patients received st and ard infection prophylaxis  that included preoperative intravenous antibiotics . Immediately before antibiotic administration and baseline aerobic and anaerobic cultures of the vaginal flora were obtained , which were followed by cultures at 30 minutes after the surgical scrub and hourly thereafter throughout each patient 's surgery . RESULTS A total of 50 patients were enrolled between October 2002 and September 2003 . There were no differences between the povidone iodine ( n = 27 ) and chlorhexidine ( n = 23 ) groups with respect to age , race , exogenous hormone use , body mass index , gravity , parity , preoperative mean colony counts , or operative time . Among the first set of intraoperative specimens ( which were obtained 30 minutes after the surgical scrub ) , 63 % of the cultures ( 17/27 ) from the povidone iodine group and 22 % of the cultures ( 5/23 ) from the chlorhexidine group were classified as contaminated ( P = .003 ; relative risk , 6.12 ; 95 % CI , 1.7 , 21.6 ) . Subsequent cultures failed to demonstrate significant differences . CONCLUSION Chlorhexidine gluconate was more effective than povidone iodine in decreasing the bacterial colony counts that were found in the operative field for vaginal hysterectomy BACKGROUND Previous studies have demonstrated higher infection rates following orthopaedic procedures on the foot and ankle as compared with procedures involving other areas of the body . Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery . The purpose of the present study was to evaluate the efficacy of three different surgical skin-preparation solutions in eliminating potential bacterial pathogens from the foot . METHODS A prospect i ve study was undertaken to evaluate 125 consecutive patients undergoing surgery of the foot and ankle . Each lower extremity was prepared with one of three r and omly selected solutions : DuraPrep ( 0.7 % iodine and 74 % isopropyl alcohol ) , Techni-Care ( 3.0 % chloroxylenol ) , or ChloraPrep ( 2 % chlorhexidine gluconate and 70 % isopropyl alcohol ) . After preparation , quantitative culture specimens were obtained from three locations : the hallux nailfold ( the hallux site ) , the web spaces between the second and third and between the fourth and fifth digits ( the toe site ) , and the anterior part of the tibia ( the control site ) . RESULTS In the Techni-Care group , bacteria grew on culture of specimens obtained from 95 % of the hallux sites , 98 % of the toe sites , and 35 % of the control sites . In the DuraPrep group , bacteria grew on culture of specimens obtained from 65 % of the hallux sites , 45 % of the toe sites , and 23 % of the control sites . In the ChloraPrep group , bacteria grew on culture of specimens from 30 % of the hallux sites , 23 % of the toe sites , and 10 % of the control sites . ChloraPrep was the most effective agent for eliminating bacteria from the halluces and the toes ( p < 0.0001 ) . CONCLUSIONS The use of effective preoperative preparation solution is an important step in limiting surgical wound contamination and preventing infection , particularly in foot and ankle surgery . Of the three solutions tested in the present study , the combination of chlorhexidine and alcohol ( ChloraPrep ) was most effective for eliminating bacteria from the forefoot prior to 
    Output:
    
There were no other statistically significant differences in SSI rates in the other comparisons of skin antisepsis .
A comprehensive review of current evidence found some evidence that preoperative skin preparation with 0.5 % chlorhexidine in methylated spirits was associated with lower rates of SSIs following clean surgery than alcohol-based povidone iodine paint .