Alcoholic Chlorhexidine or Alcoholic Iodine Skin Antisepsis Study

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The Alcoholic Chlorhexidine or Alcoholic Iodine Skin Antisepsis (ACAISA) Study is a cluster randomised controlled trial comparing alcoholic chlorhexidine to alcoholic iodine skin antisepsis at the time of surgery for prevention of superficial wound complications in patients undergoing elective prosthetic hip and knee replacement surgery. Skin antisepsis is a simple and effective strategy to remove soil and microorganisms from the patient’s skin prior to surgical incision. The three main agents commonly used for skin antisepsis are chlorhexidine, iodophors (such as iodine) or alcohol. Despite their use for over a century, no studies have adequately assessed the comparative effects of these agents on wound complication risk, particular in patients undergoing orthopaedic surgery. Joint replacement surgery is a national healthcare priority and represents high volume, high cost surgery. In 2011, 90 000 Australian patients underwent prosthetic joint surgery and this rate will double by 2020. The conservative estimate of direct medical costs for prosthetic joint surgery in Australia is $2 billion annually. Superficial wound complications are a major cause of morbidity for patients following prosthetic joint replacement surgery and are associated with increased risk of deep prosthetic joint infection. In addition, treatment of superficial wound complications are estimated to add a further $34 million annually to the direct cost of prosthetic joint surgery. Prevention of superficial wound complications will substantially decrease morbidity and mortality, improve patient outcomes and reduce the economic burden to the healthcare system. The ACAISA study represents an international first. In addition, this study is a unique collaboration between orthopaedic surgeons, infectious diseases clinicians and infection control practitioners in both the public and private healthcare sector.