Chlorhexidine Cloths to Reduce Surgical Site Infection in Cesarean Deliveries


Pregnancy-associated infection represents a major cause of maternal morbidity and mortality. Cesarean delivery is the most common major surgical procedure and is associated with a rate of surgical site infection (SSI) that is approximately 5-10 times the rate for vaginal delivery. Efforts to reduce the risk of SSIs in this patient population include the use of preoperative antibiotic prophylaxis in addition to skin and vaginal antiseptic preparations.Nevertheless, the rate of SSI in women undergoing non-scheduled cesarean delivery is up to 18%, a significant number that contributes to prolonged hospital stays and increased health care costs. Every effort should be made to reduce this major cause of pregnancy-associated morbidity and mortality to aid in the care of patients and reduce the associated prolonged hospital stays, readmission rates and health care costs. Studies have shown that preoperative application of chlorhexidine cloths reduces the risk of SSI, however this is based on literature in the orthopedic and intensive care patients. The efficacy of this intervention has not been studied in obstetric patients undergoing cesarean delivery. Furthermore, obstetric patients undergoing non-scheduled cesarean delivery represent a target population as it is thought that infectious morbidity is higher in this patient population. Therefore, there is a need for this trial to determine if this intervention is effective in reducing the rate of postoperative SSIs.

Full Title of Study: “Preoperative Chlorhexidine Cloths to Reduce Surgical Site Infection in Non-Scheduled Cesarean Deliveries”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Prevention
    • Masking: Double (Care Provider, Investigator)
  • Study Primary Completion Date: June 1, 2021

Detailed Description

This randomized clinical trial will be investigating the use of preoperative chlorhexidine cloths, a chemical skin antiseptic agent effective on gram positive and gram negative bacteria, as an intervention to reduce the rate of surgical site infections (SSIs). The intervention group will be women undergoing non-scheduled cesarean delivery randomized to receive preoperative abdominal application of 2% chlorhexidine cloths. The control group will be women undergoing non-scheduled cesarean delivery randomized to receive standard preoperative care. The impact on women's health is significant, as a reduction in SSIs in this prevalent patient population can reduce the number of prolonged hospital stays, outpatient follow-ups for infection, hospital readmissions and health care costs.


  • Device: Chlorhexidine Cloth
    • 2% chlorhexidine gluconate cloth

Arms, Groups and Cohorts

  • Experimental: Chlorhexidine Cloth
    • The intervention group will be women undergoing non-scheduled cesarean delivery randomized to receive preoperative abdominal application of 2% chlorhexidine cloths.
  • No Intervention: Standard Preoperative Care
    • The no intervention group will be women undergoing non-scheduled cesarean delivery randomized to receive standard preoperative care.

Clinical Trial Outcome Measures

Primary Measures

  • Rate of surgical site infection
    • Time Frame: Up to 6 weeks after cesarean delivery

Secondary Measures

  • Hospital length of stay
    • Time Frame: Up to 6 weeks after cesarean delivery
  • Number of office visits
    • Time Frame: Up to 6 weeks after cesarean delivery
  • Number of hospital readmissions for infection-related complications
    • Time Frame: Up to 6 weeks after cesarean delivery
  • Rate of endometritis
    • Time Frame: Up to 6 weeks after cesarean delivery
  • Rate of positive wound culture from wound
    • Time Frame: Up to 6 weeks after cesarean delivery

Participating in This Clinical Trial

Inclusion Criteria

  • undergoing non-scheduled cesarean delivery > 23 weeks gestation Exclusion Criteria:

  • allergy to chlorhexidine, emergency cesarean delivery, evidence of infection at operative site

Gender Eligibility: Female

Minimum Age: 18 Years

Maximum Age: 50 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Northwell Health
  • Provider of Information About this Clinical Study
    • Principal Investigator: Moti Gulersen, Principal Investigator – Northwell Health


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