Preoperative Antisepsis with Chlorhexidine Versus Povidone‐Iodine for the Prevention of Surgical Site Infection: a Systematic Review and Meta‐analysis

Abstract

Background and Objective Chlorhexidine (CH) and povidone-iodine (PI) are the most commonly used preoperative skin antiseptics at present. However, the prevention of the surgical site infection (SSI) and the incidence of skin adverse events do not reach a consistent statement and conclusion. This meta-analysis aimed to evaluate the efficacy of chlorhexidine and povidone-iodine in the prevention of postoperative surgical site infection and the incidence of corresponding skin adverse events. Method Substantial studies related to ''skin antiseptic'' and ''surgical site infection'' were consulted on PUBMED, Web of Science, EMBASE, and CNKI. The primary outcome was the incidence of postoperative SSI. The secondary outcome was associated with skin adverse events. All data were analyzed with Revman 5.3 software. Results A total of 30 studies were included, including 29,006 participants. This study revealed that chlorhexidine was superior to povidone-iodine in the prevention of postoperative SSI (risk ratio [RR], 0.65; 95% confidence interval [CI], 0.55-0.77; p \ 0.00001, I 2 = 57%). Further subgroup analysis showed that chlorhexidine was superior to povidone-iodine in the prevention of postoperative SSI in clean surgery (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.67-0.98; p = 0.03), I 2 = 28%) and clean-contaminated surgery (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.47-0.73; p \ 0.00001, I 2 = 43%). However, there was no statistically significant difference in the incidence of skin adverse events between CH and PI groups. Conclusion Chlorhexidine was superior to povidone-iodine in preventing postoperative SSI, especially for the cleancontaminated surgery. However, there was no statistically significant difference in the incidence of skin adverse events between CH and PI groups.

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

“…A wide spectrum of paint solutions, including both alcohol-and non-alcohol-based agents, have been certified for this purpose [106], but evidence for a particular product is limited. A recent systematic review and meta-analysis found superior benefit for chlorhexidine compared to povidone-iodine in clean surgery in terms of prevention of postoperative SSIs (risk ratio 0.81; 95% CI, 0.67-0.98) [107]. Concerns persist, however, regarding the effective concentration of chlorhexidine, given a report stating that even with 4% chlorhexidine, skin bacteria could still be cultivated from healthy volunteers [108].…”

On the function of biosynthesized cellulose as barrier against bacterial colonization of VAD drivelines

“…This correlation appears to be especially relevant considering that, despite skin disinfection with povidone-iodine solution, the majority of implant sites in our study were contaminated prior to implantation. Based on the observations reported in our work and other clinical studies which describe higher wound infection rates using povidone-iodine solution for surgical antisepsis, as compared to a chlorhexidine solution, a chlorhexidine-based skin disinfectant should be considered as antiseptic of choice in future studies 23 .…”

Development and Evaluation of a Polyvinylalcohol -Cellulose Derivative-Based Film with Povidone-Iodine Predicted for Wound Treatment

“…The dressings we prepared (with PVA-HPMC, as with other combinations described in the literature) are characterized by enhanced properties, i.e., swelling or flexibility relative to pure PVA [ 40 , 41 ]. Povidone-iodine (PVP-I) was selected as the active drug in films, as it displays the broadest spectrum of antimicrobial effects against bacteria, yeasts, molds, other fungi, and certain viruses, and at the same time, microbes lack resistance to the compound [ 42 , 43 , 44 , 45 , 46 ]. Kaeviad et al developed dental floss impregnated with PVP-I as a drug antimicrobial delivery system against periodontopathogenic bacteria.…”