Chlorhexidine versus povidone iodine for preventing surgical site infections: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

TIAN Leilei ^1# , LAI Li ^1# , LUO Yuan ¹ , LIU Yuanting ¹ ,  YANG Lu ²

1. Centre of Anesthesia and Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Urology, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

YANG Lu, Email: wycleflue@163.com

Keywords：

Chlorhexidine; Povidone iodine; Surgical site infections; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201701028

Video：

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Objective To systematically review the efficacy of chlorhexidine versus povidone iodine in the prevention of wound infections after surgeries by meta-analysis. Methods All randomized controlled trials comparing these two disinfectants were searched from databases of PubMed, The Cochrane Library (Issue 3, 2016), EMbase, WanFang Data, VIP and CNKI from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 14 randomized controlled trials were included. The results of meta-analysis showed that the chlorhexidine group had significantly lower rates in any surgical site infection (RR=0.71, 95% CI 0.58 to 0.88,P=0.001) and superficial incisional infection (RR=0.66, 95% CI 0.48 to 0.91,P=0.01) when compared with povidone iodine group. However, there were no significant differences in deep incisional infection (RR=0.51, 95% CI 0.23 to 1.11,P=0.09) and organ-space infection (RR=0.97, 95% CI 0.53 to 1.76,P=0.92) between the two groups. Furthermore, subgroup analysis revealed differences in any surgical site infection and superficial incisional infection could only be found in surgeries possibly contaminated. Conclusion Chlorhexidine may be superior in decreasing the incidence of infection in probably contaminated surgery.

Citation： TIAN Leilei, LAI Li, LUO Yuan, LIU Yuanting, YANG Lu. Chlorhexidine versus povidone iodine for preventing surgical site infections: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(5): 557-563. doi: 10.7507/1672-2531.201701028 Copy

1.	Lundberg PW, Smith AA, Heaney JB, et al. Pre-Operative Antisepsis Protocol Compliance and the Effect on Bacterial Load Reduction. Surg Infect, 2016, 17(1): 32-37.
2.	Guzel A, Ozekinci T, Ozkan U, et al. Evaluation of the skin flora after chlorhexidine and povidone-iodine preparation in neurosurgical practice. Surg Neurol, 2009, 71(2): 207-210.
3.	Davies BM, Patel HC. Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery? Ann R Coll Surg Engl, 2016, 98(6): 405-408.
4.	Bibi S, Shah SA, Qureshi S, et al. Is chlorhexidine-gluconate superior than Povidone-Iodine in preventing surgical site infections? A multicenter study. J Pak Med Assoc, 2015, 65(11): 1197-1201.
5.	Ngai IM, Van Arsdale A, Govindappagari S, et al. Skin preparation for prevention of surgical site infection after cesarean delivery: a randomized controlled trial. Obstet Gynecol, 2015, 126(6): 1251-1257.
6.	Srinivas A, Kaman L, Raj P, 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): 1378-1384.
7.	Abreu D, Campos E, Seija V, et al. Surgical site infection in surgery for benign prostatic hyperplasia: comparison of two skin antiseptics and risk factors. Surg Infect, 2014, 15(6): 763-767.
8.	Kunkle CM, Marchan J, Safadi S, et al. Chlorhexidine gluconate versus povidone iodine at cesarean delivery: a randomized controlled trial. J Matern Fetal Neonatal Med, 2015, 28(5): 573-577.
9.	Rodrigues AL, Simoes Mde L. Incidence of surgical site infection with pre-operative skin preparation using 10% polyvidone-iodine and 0. 5% chlorhexidine-alcohol. Rev Col Bras Cir, 2013, 40(6): 443-448.
10.	Darouiche RO, Wall MJ Jr., Itani KM, et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med, 2010, 362(1): 18-26.
11.	Sistla SC, Prabhu G, Sistla S, et al. Minimizing wound contamination in a ’clean’ surgery: comparison of chlorhexidine-ethanol and povidone-iodine. Chemotherapy, 2010, 56(4): 261-267.
12.	Cheng K, Robertson H, St Mart JP, et al. Quantitative analysis of bacteria in forefoot surgery: a comparison of skin preparation techniques. Foot Ankle Int, 2009, 30(10): 992-997.
13.	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.
14.	Veiga DF, Damasceno CA, Veiga-Filho J, et al. Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. Plast Reconstr Surg, 2008, 122(5): 170e-171e.
15.	Culligan PJ, Kubik K, Murphy M, et al. A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy. Am J Obstet Gynecol, 2005, 192(2): 422-425.
16.	Bibbo C, Patel DV, Gehrmann RM, et al. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res, 2005, 438: 204-208.
17.	Hadiati DR, Hakimi M, Nurdiati DS, et al. Skin preparation for preventing infection following caesarean section. Cochrane Database Syst Rev, 2014, (9): Cd007462.
18.	Lai NM, Lai NA, O’Riordan E, et al. Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database Syst Rev, 2016, (7): Cd010140.
19.	Tanner J, Dumville JC, Norman G, et al. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev, 2016, (1): Cd004288.
20.	Fleischer W, Reimer K. Povidone-iodine in antisepsis-state of the art. Dermatology, 1997, 195(Suppl 2): 3-9.
21.	Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: Expanding the armamentarium for infection control and prevention. Clin Infect Dis, 2008, 46(2): 274-281.
22.	Dumville JC, McFarlane E, Edwards P, et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev, 2015, (4): Cd003949.
23.	Kulkarni AP, Awode RM. A prospective randomised trial to compare the efficacy of povidone-iodine 10% and chlorhexidine 2% for skin disinfection. Indian J Anaesth, 2013, 57(3): 270-275.
24.	Becerro de Bengoa Vallejo R, Losa Iglesias ME, Alou Cervera L, et al. Preoperative skin and nail preparation of the foot: comparison of the efficacy of 4 different methods in reducing bacterial load. J Am Acad Dermatol, 2009, 61(6): 986-992.

1. Lundberg PW, Smith AA, Heaney JB, et al. Pre-Operative Antisepsis Protocol Compliance and the Effect on Bacterial Load Reduction. Surg Infect, 2016, 17(1): 32-37.
2. Guzel A, Ozekinci T, Ozkan U, et al. Evaluation of the skin flora after chlorhexidine and povidone-iodine preparation in neurosurgical practice. Surg Neurol, 2009, 71(2): 207-210.
3. Davies BM, Patel HC. Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery? Ann R Coll Surg Engl, 2016, 98(6): 405-408.
4. Bibi S, Shah SA, Qureshi S, et al. Is chlorhexidine-gluconate superior than Povidone-Iodine in preventing surgical site infections? A multicenter study. J Pak Med Assoc, 2015, 65(11): 1197-1201.
5. Ngai IM, Van Arsdale A, Govindappagari S, et al. Skin preparation for prevention of surgical site infection after cesarean delivery: a randomized controlled trial. Obstet Gynecol, 2015, 126(6): 1251-1257.
6. Srinivas A, Kaman L, Raj P, 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): 1378-1384.
7. Abreu D, Campos E, Seija V, et al. Surgical site infection in surgery for benign prostatic hyperplasia: comparison of two skin antiseptics and risk factors. Surg Infect, 2014, 15(6): 763-767.
8. Kunkle CM, Marchan J, Safadi S, et al. Chlorhexidine gluconate versus povidone iodine at cesarean delivery: a randomized controlled trial. J Matern Fetal Neonatal Med, 2015, 28(5): 573-577.
9. Rodrigues AL, Simoes Mde L. Incidence of surgical site infection with pre-operative skin preparation using 10% polyvidone-iodine and 0. 5% chlorhexidine-alcohol. Rev Col Bras Cir, 2013, 40(6): 443-448.
10. Darouiche RO, Wall MJ Jr., Itani KM, et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med, 2010, 362(1): 18-26.
11. Sistla SC, Prabhu G, Sistla S, et al. Minimizing wound contamination in a ’clean’ surgery: comparison of chlorhexidine-ethanol and povidone-iodine. Chemotherapy, 2010, 56(4): 261-267.
12. Cheng K, Robertson H, St Mart JP, et al. Quantitative analysis of bacteria in forefoot surgery: a comparison of skin preparation techniques. Foot Ankle Int, 2009, 30(10): 992-997.
13. 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.
14. Veiga DF, Damasceno CA, Veiga-Filho J, et al. Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. Plast Reconstr Surg, 2008, 122(5): 170e-171e.
15. Culligan PJ, Kubik K, Murphy M, et al. A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy. Am J Obstet Gynecol, 2005, 192(2): 422-425.
16. Bibbo C, Patel DV, Gehrmann RM, et al. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res, 2005, 438: 204-208.
17. Hadiati DR, Hakimi M, Nurdiati DS, et al. Skin preparation for preventing infection following caesarean section. Cochrane Database Syst Rev, 2014, (9): Cd007462.
18. Lai NM, Lai NA, O’Riordan E, et al. Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database Syst Rev, 2016, (7): Cd010140.
19. Tanner J, Dumville JC, Norman G, et al. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev, 2016, (1): Cd004288.
20. Fleischer W, Reimer K. Povidone-iodine in antisepsis-state of the art. Dermatology, 1997, 195(Suppl 2): 3-9.
21. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: Expanding the armamentarium for infection control and prevention. Clin Infect Dis, 2008, 46(2): 274-281.
22. Dumville JC, McFarlane E, Edwards P, et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev, 2015, (4): Cd003949.
23. Kulkarni AP, Awode RM. A prospective randomised trial to compare the efficacy of povidone-iodine 10% and chlorhexidine 2% for skin disinfection. Indian J Anaesth, 2013, 57(3): 270-275.
24. Becerro de Bengoa Vallejo R, Losa Iglesias ME, Alou Cervera L, et al. Preoperative skin and nail preparation of the foot: comparison of the efficacy of 4 different methods in reducing bacterial load. J Am Acad Dermatol, 2009, 61(6): 986-992.

Chinese Journal of Evidence-Based Medicine

Chlorhexidine versus povidone iodine for preventing surgical site infections: a meta-analysis

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