Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis

  • Tasya Anggrahita Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
  • Aditya Wardhana Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
  • Gentur Sudjatmiko Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
Keywords: chlorhexidine-alcohol, povidone-iodine, skin antisepsis, surgical site infection
Abstract viewed: 7459 times
PDF downloaded: 2941 times
HTML downloaded: 587 times
EPUB downloaded: 131 times

Abstract

Background: Surgical site infection remains substantial problems to surgeons and patients as it increases the morbidity, mortality, length of stay, hospital cost, rate of re-admission, and rate of re-surgery. This study aims to compare the use of chlorhexidine-alcohol versus povidone-iodine for preoperative skin preparation to prevent surgical site infection.

Methods: The literature search was conducted through the PubMed database on November 2015. Included studies were RCTs with the year of publication up to 2015 which compared the use of chlorhexidine-alcohol versus povidone-iodine in its effectiveness reducing surgical site infection in adult patients. The quality of the study was assessed using Jadad Score. A meta-analysis was conducted in the included study to obtain a pooled estimate of the effect size. The evidence of heterogeneity and publication bias was also assessed.

Results: Six RCTs with a total of 2,080 patients were included in the meta-analysis. It showed that the use of chlorhexidine-alcohol was associated significantly with fewer SSIs (pooled risk ratio=0.60 (95% CI=0.45-0.79)) and fewer positive skin culture results (pooled risk ratio, RR=0.38 (95% CI=0.28-0.51)) compared with povidone iodine.

Conclusion: Preoperative skin antisepsis with chlorhexidine is more effective than povidone-iodine in preventing surgical site infection.

References

  1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20(4):250–778. https://doi.org/10.1086/501620

  2. Yeung LL, Grewal S, Bullock A, Lai HH, Brandes SB. A comparison of chlorhexidine-alcohol versus povidone-iodine for eliminating skin flora before genitourinary prosthetic surgery: a randomized controlled trial. J Urol. 2013;189(1):136–40. https://doi.org/10.1016/j.juro.2012.08.086

  3. McKenna PJ, Lehr GS, Leist P, Welling RE. Antiseptic effectiveness with fibroblast preservation. Ann Plast Surg. 1991;27(3):265-8. https://doi.org/10.1097/00000637-199109000-00011

  4. Welch JS. Efficacy and safety of povidone-iodine underscored. J Emerg Nurs. 1992;18(3):191–2.

  5. Shetty KR, Duthie EH Jr. Thyrotoxicosis induced by topical iodine application. Arch Intern Med. 1990;150(11):2400–1. https://doi.org/10.1001/archinte.1990.00390220132028

  6. 3m.com [Internet]. DuraPrep surgical solution (iodine povacrylex [0.7% available iodine] and isopropyl alcohol, 74% w/w) patient preoperative skin preparation. . [cited November 2015]. Available from: http://solutions.3m.com/wps/portal/3M/en_US/SH/SkinHealth/products/catalog/? PC_7_RJH9U5230GE3E02LECFTDQG207_nid=GSF83Z3YYXbeJLRV63SXXBgl.

  7. Hibbard JS. Analyses comparing the antimicrobial activity and safety of current antiseptics: a review. J Infus Nurs. 2005;28(3):194–207. https://doi.org/10.1097/00129804-200505000-00008

  8. who.int [Internet]. WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care [update: 2009; cited: 2015]. Available from: http://www.who.int/gpsc/5may/tools/9789241597906/en/

  9. Saaiq M, S Zaib, S Ahmad. Electrocautery burns: experience with three cases and review of literature. Ann Burns Fire Disasters. 2012;25(4):203–6.

  10. McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999;12(1):147–79.

  11. Lim KS, Kam PC. Chlorhexidine--pharmacology and clinical applications. Anaesth Intensive Care. 2008;36(2):502–12.

  12. Sibbald RG, Leaoer DJ, Queen D. Iodine made easy. Wounds International. 2011; 2(2):s1–6.

  13. Darouiche RO, Wall MJ Jr, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med. 2010;362(1):18–26. https://doi.org/10.1056/NEJMoa0810988

  14. Noorani A, Rabey N, Walsh SR, Davies RJ. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg. 2010;97(11):1614–20. https://doi.org/10.1002/bjs.7214

  15. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162–93. https://doi.org/10.1093/cid/cir138

  16. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized control trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12. https://doi.org/10.1016/0197-2456(95)00134-4

  17. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557

  18. Egger M. Under the meta-scope: possibilities and limits of meta-analyses. Schweiz Med Wochenschr. 1998;128(48):1893–901. Germany.

  19. community.cochrane.org [Internet]. Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014. Available from: http://community.cochrane.org/tools/review-production-tools/revman-5

  20. Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am. 2009;91(8):1949–53. https://doi.org/10.2106/JBJS.H.00768

  21. Veiga DF, Damasceno CA, Veiga-Filho J, Figueiras RG, Veira RB, Florenzano FH, et al. Plast Reconstr Surg. 2008;122(5):170e–1e. https://doi.org/10.1097/PRS.0b013e318186cd7f

  22. Srinivas A, Kaman L, Raj P, Gautam V, Dahiya D, Singh G, et al. Comparison of the efficacy of chlorhexidine gluconate versus povidone iodine as preoperative skin preparation for the prevention of surgical site infections in clean-contaminated upper abdominal surgeries. Surg Today. 2015;45(11):1378–84. https://doi.org/10.1007/s00595-014-1078-y

  23. Kunkle CM, Marchan J, Safadi S, Whitman S, Chmait RH. Chlorhexidine gluconate versus povidone iodine at cesarean delivery: a randomized controlled trial. J Matern Fetal Neonatal Med. 2015;28(5):573–7. https://doi.org/10.3109/14767058.2014.926884

  24. Paocharoen V, Mingmalairak C, Apisarnthanarak A. Comparison of surgical wound infection after preoperative skin preparation with 4% chlorhexidine [correction of chlohexidine] and povidone iodine: a prospective randomized trial. J Med Assoc Thai. 2009;92(7):898–902.

  25. Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol. 2010;31(12):1219–29. https://doi.org/10.1086/657134

Published
2017-05-16
How to Cite
1.
Anggrahita T, Wardhana A, Sudjatmiko G. Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis. Med J Indones [Internet]. 2017May16 [cited 2024Apr.19];26(1):54-1. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/1388
Section
Clinical Research