***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    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 . 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 OBJECTIVE We estimated the impact of hip replacement-associated surgical site infection ( SSI ) on morbidity and length of stay . METHODS This was a pairwise matched ( 1 : 1 ) case-control study nested in a cohort . All patients who underwent hip replacement from January 1 , 2000 , to June 30 , 2004 , were prospect ively enrolled for the nested case-control design analysis and were monitored from the time of surgery until hospital discharge , including any patients readmitted because of infection . RESULTS Among the 1,260 hip replacements performed , 28 SSIs were detected , yielding a crude SSI rate of 2.2 % . The median excess length of stay attributable to SSI was 32.5 days ( P<.001 ) , whereas the median prolonged postoperative stay due to SSI was 31 days ( P<.001 ) . Deep-wound SSI was the type that prolonged hospital stay the most ( up to 49 days ) . Of the patients who developed an SSI , 4 required revision surgery , for an SSI-related morbidity rate of 14.3 % . CONCLUSION SSI prolongs hospital stay ; however , although hospital stay is a rough indicator of the cost of this complication , to accurately estimate the costs of SSI , we would need to consider individual costs in a linear regression model adjusted for all possible confounding factors OBJECTIVE To analyze the incidence of surgical site infection when the preoperative skin preparation was performed with 10 % povidone-iodine and 0.5 % chlorhexidine-alcohol . METHODS We conducted a r and omized , longitudinal study based on variables obtained from patients undergoing clean and potentially contaminated operations . Those involved were divided into two groups . In group 1 ( G1 ) we included 102 patients with skin prepared with povidone-iodine , and in group 2 ( G2 ) , 103 , whose skin was prepared with chlorhexidine .  In the third , seventh and 30th postoperative days we evaluated the surgical site , search ing for signs of infection . RESULTS Data related to clinical profile , such as diabetes mellitus , smoking , alcoholism , haematological data ( Hb , VG and leukocytes ) , age and gender , and the related variables , such as number of days of preoperative hospitalization , shaving , topography of incision , antibiotic prophylaxis and resident participation in the operation were not predisposing factors for surgical site infection . Two patients in G1 and eight in G2 undergoing clean operations had some type of infection ( p = 0.1789 ) , five in G1 and three in G2 undergoing potentially contaminated operations had some type of infection ( p = 0.7205 ) . CONCLUSION The incidence of surgical site infection in operations classified as clean and as potentially contaminated for which skin preparation was done with 10 % povidone-iodine and 0.5 % chlorhexidine-alcohol was similar Abstract Background / Aims : To compare the prevalence of positive bacterial cultures at the cesarean delivery ( CD ) incision site in patients with pre-operative application of chlorhexidine gluconate ( CG ) versus povidone iodine ( PI ) .  Methods : Women undergoing a scheduled CD at ≥36 gestational weeks were r and omly assigned to receive CG or PI . A swab of the incision site was performed at 3 min after disinfectant application and at 18 post-operative hours , and the prevalence of cultures with any detected bacterial growth was compared for the two groups . Results : Of the 60 participants , 33 ( 55.0 % ) were in the PI group . There were no differences detected at 3 min , with 9.1 % positive in the PI group versus 0 % positive in the CG group ( p = 0.2499 ) . However , at 18 h , women in the PI group were seven times more likely than women in the CG group to have a positive culture ( 16/33 [ 48.5 % ] versus 3/27 [ 11.1 % ] , OR = 7.53 [ 95 % CI 1.67–38.83 ] , p = 0.0023 ) . Multivariate logistic regression demonstrated similar results : OR = 7.33 ( 95 % CI 1.77–30.35 ) , p = 0.0060 . Conclusion : The prevalence of positive bacterial cultures obtained at the site of the skin incision 18 h after CD was higher in the PI versus the CG group BACKGROUND Postoperative spinal wound infections are relatively common and are often associated with increased morbidity and poor long-term patient outcomes . The purpose s of this study were to identify the common bacterial flora on the skin overlying the lumbar spine and evaluate the efficacy of readily available skin-preparation solutions in the elimination of bacterial pathogens from the surgical site following skin preparation . METHODS A prospect i ve r and omized study was undertaken to evaluate 100 consecutive patients undergoing elective lumbar spine surgery . At the time of surgery , the patients were r and omized to be treated with one of two widely used , and Food and Drug Administration ( FDA ) -approved , surgical skin-preparation solutions : ChloraPrep ( 2 % chlorhexidine gluconate and 70 % isopropyl alcohol ) or DuraPrep ( 0.7 % available iodine and 74 % isopropyl alcohol ) . Specimens for aerobic and anaerobic cultures were obtained prior to skin preparation ( pre-preparation ) , after skin preparation ( post-preparation ) , and after wound closure ( post-closure ) . A vali date d neutralization solution was used for each culture to ensure that the antimicrobial activity was stopped immediately after the sample was taken . Positive cultures and specific bacterial pathogens were recorded . RESULTS Coagulase-negative Staphylococcus , Propionibacterium acnes , and Corynebacterium were the most commonly isolated organisms prior to skin preparation . The overall rate of positive cultures prior to skin preparation was 82 % . The overall rate of positive cultures after skin preparation was 0 % ( zero of fifty ) in the ChloraPrep group and 6 % ( three of fifty ) in the DuraPrep group ( p = 0.24 , 95 % confidence interval [ CI ] = 0.006 to 0.085 ) . There was an increase in positive cultures after wound closure , but there was no difference between the ChloraPrep group ( 34 % , seventeen of fifty ) and the DuraPrep group ( 32 % , sixteen of fifty ) ( p = 0.22 , 95 % CI = 0.284 to 0.483 ) . Body mass index ( BMI ) , duration of surgery , and estimated blood loss did not a show significant association with post-closure positive culture results . CONCLUSIONS ChloraPrep and DuraPrep are equally effective skin-preparation solutions for eradication of common bacterial pathogens on the skin overlying the lumbar spine 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 Surgical site infections ( SSI ) remain a major clinical problem in terms of morbidity , mortality , and hospital costs . Nearly 60 % of SSI diagnosis occur in the postdischarge period . However , literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence . A national prospect i ve multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI , and the associated risk factors . Methods In 2002 , a one-month , prospect i ve national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals . Case ascertainment of SSI was carried out using st and ardized surveillance methodology . To assess potential risk factors for SSI we used a conditional logistic regression model . We also reported the odds ratios of in-hospital and postdischarge SSI . Results SSI occurred in 241 ( 5.2 % ) of 4,665 patients , of which 148 ( 61.4 % ) during in-hospital , and 93 ( 38.6 % ) during postdischarge period . Of 93 postdischarge SSI , sixty-two ( 66.7 % ) and 31 ( 33.3 % ) were detected through telephone interview and question naire survey , respectively . Higher SSI incidence rates were observed in colon surgery ( 18 
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Conclusions : There is moderate‐ quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high‐ quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures .