Comment on “Preoperative Vaginal Preparation and Infection After Gynecologic Surgery”

One of the most common complications of gynecologic surgery is surgical site infection (SSI), which in turn leads to increased risk of morbidity and readmission. Mitigating SSI can be accomplished using several methods, among which is preoperative antiseptics. Preoperative vaginal washes can be used to decrease bacterial counts and wound infections, and previous literature has shown that chlorohexidine gluconate (CHG) can be used with greater efficacy than providone iodine (PI). Though there is consensus that preoperative vaginal antiseptics can improve outcomes and reduce SSIs, the ideal antiseptic agent is an item of debate. There is no established guideline for the type of vaginal preparation; this study was designed to assess the association between the type of vaginal preparation and the rate of SSI after any gynecologic surgery, including but not limited to hysterectomy. This was a retrospective case-control study using data from a single urban academic medical center between 2010 and 2023. Inclusion criteria were patients who underwent elective gynecologic surgery where vaginal preparation was indicated. The primary outcome for this study was the association between the type of vaginal preparation and SSI rate within 30 days. Vaginal preparation included chlorhexidine or iodine. Secondary outcomes included other SSI risk factors. Final analysis included 101 cases of SSI and 404 controls. Treatment for SSI typically includes oral or intravenous antibiotics, with occasional percutaneous drainage or surgical washout. Almost all patients received preoperative antibiotics, and CHG was the most common skin antiseptic and the least common vaginal antiseptic. Patients with SSI were more likely to have government insurance ( P = 0.01), and the rates of immunosuppression, chronic steroid use, and current smoker status were higher in the SSI group ( P < 0.01 for all). Skin antiseptic type was not significantly associated with SSI, but the use of vaginal iodine was associated with a significantly greater likelihood of SSI compared with vaginal CHG ( P < 0.01). Patients with SSI were more likely to have other postoperative complications, be readmitted, or have a repeat procedure ( P < 0.01 for all). These results indicate that vaginal preparation with CHG is associated with a decreased likelihood of SSI, consistent with previous literature surrounding CHG and its efficacy in reducing bacterial count, but inconsistent with previous studies that showed no difference between types of vaginal preparation. These results suggest that CHG can be safely and confidently used for vaginal preparation, particularly in high-risk populations. Further research should validate these findings in a larger sample, as well as expand to specific populations at higher risk of SSI. (Summarized from Samsel T, Ashmore S, Gugerty L, et al. Preoperative vaginal preparation and infection after gynecologic surgery. Urogynecology . 2026;32(3):257–264. doi: 10.1097/SPV.0000000000001793)