Ademuyiwa AO, Hardy P, Runigamugabo E, et al. - As prophylactic interventions for surgical site infection (SSI), no benefit was conferred by 2% alcoholic chlorhexidine skin preparation vs povidone–iodine, or by triclosan-coated sutures vs non-coated sutures, in clean-contaminated or contaminated or dirty surgical wounds. More cost is associated with both interventions vs alternatives, and recommendations for routine use are not backed.

• A 2 × 2 factorial, randomised controlled trial (FALCON ) to test two preventive interventions for SSI in low-income and middle-income countries.

• Stratification was done based on whether surgery was clean-contaminated, or contaminated or dirty.

• Patients were randomised to alcoholic chlorhexidine and non-coated suture, to alcoholic chlorhexidine and triclosan-coated suture, to aqueous povidone–iodine and non-coated suture, and to aqueous povidone–iodine and triclosan-coated suture.

• The overall SSI rate was estimated to be 22·0% (1163/5284; clean-contaminated stratum 15·5% [454/2923], contaminated or dirty stratum 30·0% [709/2361]).

• Risk of SSI did not differ with alcoholic chlorhexidine vs povidone–iodine, or with triclosan-coated sutures vs non-coated sutures, for both strata.

• No differences were observed using alcoholic chlorhexidine or triclosan-coated sutures, when both strata were combined.