Thank you for allowing us the opportunity to respond to the question raised by Dr. Maiwald regarding our randomized controlled trial evaluating skin preparation for prevention of surgical site infection after cesarean birth.1 In a review of the World Health Organization guidelines for the prevention of surgical site infections, our study was not included in the meta-analysis.2 The logic for exclusion is unclear to us given the range of publication dates of the references.
Our skin preparation solutions used were as follows: the chlorhexidine-alcohol group used ChloraPrep with Tint, Hi-Lite Orange: 2% wt/vol Chlorhexidine gluconate and 70% vol/vol isopropyl alcohol, with the total volume 26 mL. The povidone-iodine-alcohol group used Prevail-FX one-step application solution: povidone-iodine USP 8.3% (0.83% available iodine) with isopropyl alcohol 72.5% wt/wt isopropyl alcohol, total volume 40 mL.
We would be interested to see an updated meta-analysis from the World Health Organization in which our randomized trial and any other randomized trials with skin preparation solutions containing appropriate ingredients are included. We also concur that skin preparation is an integral step for the reduction of surgical site infections and is applicable worldwide.