Critical Care Medicine
of pathogens is skin, proper preoperative skin antisepsis is crucial to minimize postoperative infections. The main objective of this large, prospective randomized trial was to determine whether preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than treatment with povidone-iodine. All patients received systemic antibiotics preoperatively. Patients (n ϭ 849) undergoing clean-contaminated surgery in six hospitals were randomized to receive preoperative
... n preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The incidence and type of surgical-site infection occurring within 30 days after surgery were recorded. The relative risk of surgical site infection among patients who received clorhexidine-alcohol scrub versus povidine-iodine was 0.59 (95% CI, 0.41-0.85). Interpretation For clean-contaminated surgery, surgical-site infection was significantly reduced in patients who received chlorhexidine-alcohol compared with 10% povidone-iodine skin preparation. Improving skin antisepsis can decrease skin and deep surgical-site infections but not organ infections. Treatment of postpartum hemorrhage with sublingual misoprostol versus oxytocin in women not exposed to oxytocin during labor: A double-blind, randomized, noninferiority trial. Lancet 2010; 375:210 -6 Treatment of postpartum hemorrhage with sublingual misoprostol versus oxytocin in women receiving prophylactic oxytocin: A double-blind, randomized, noninferiority trial. Lancet 2010; 375:217-23 Postpartum hemorrhage (PPH) is a major contributor to maternal morbidity and mortality worldwide, and the risk of dying is 100 times higher in developing countries likely because of limited skilled personnel, uterotonic drug access, and other resources. Currently, oxytocin is the accepted standard of treatment for PPH; however, it is difficult to store and administer in resource-poor settings. Another uterotonic agent, misoprostol, is a low-cost and easy-to-use alternative. These two double-blind, large, randomized, multicenter trials compared the effects of oxytocin and misoprostol in postpartum women who were or were not exposed to oxytocin during labor in Egypt, Turkey, and Vietnam. After diagnosis of PPH and randomization, patients received either 40 IU oxytocin intravenously or 800 g misoprostol sublingually and placebo for the other treatment (i.e., saline placebo pills or intravenously administered saline). The primary outcomes were the proportion of women who stopped bleeding within 20 min of treatment and those with more than 300 ml blood loss after treatment. Active bleeding was controlled within 20 min in the majority of patients regardless of the treatment group (see table on next page). Interpretation PPH is a major risk of death. Although oxytocin is the drug of choice, it is difficult to store, requires personnel for administration, and requires intravenous access. Misoprostol is inexpensive, stable at room temperature, and can be administered sublingually. In these two studies, misoprostol was shown to be effective in controlling postpartum bleeding and an alternative to oxytocin for the treatment of primary PPH after oxytocin prophylaxis during the third stage of labor. Sublingually administered misoprostol could reduce worldwide maternal mortality from PPH.