Evaluation of the efficacy of chlorhexidine-alcohol vs. aqueous/alcoholic iodine solutions for the prevention of surgical site infections: a systematic review and meta-analysis.

Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 101228232 Publication Model: Electronic Cited Medium: Internet ISSN: 1743-9159 (Electronic) Linking ISSN: 17439159 NLM ISO Abbreviation: Int J Surg Subsets: MEDLINE

Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc.
Original Publication: London : Surgical Associates Ltd., c2004-

Surgical Wound Infection*/prevention & control ; Chlorhexidine*/administration & dosage ; Anti-Infective Agents, Local*/administration & dosage ; Iodine*/administration & dosage; Humans ; Randomized Controlled Trials as Topic ; Alcohols/administration & dosage

Background: Surgical site infection (SSI) is the prevailing complication that occurs after surgery and significantly escalates healthcare expenses. Published meta-analyses and international standards vary in their recommendations for the most effective preoperative skin antiseptic solution and concentration.
Objective: The aim of this systematic review and meta-analysis is to assess the effectiveness of chlorhexidine-alcohol compared to aqueous/alcoholic iodine solutions in preventing postoperative surgical site infections.
Methods: A systematic search was conducted using four electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals. The risk ratio (RR) was calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane Q and I2 statistics and the appropriate P value. The analysis used RevMan 5.4.
Results: The current meta-analysis includes 14 randomized controlled trials (RCTs) comparing either 2-2.5% chlorhexidine-alcohol with aqueous/alcoholic iodine. It was demonstrated that the CAG-using group had an overall lower incidence of postoperative surgical site infections compared to the iodine-using group (RR=0.30, 95% CI=0.20-0.46, I2 =95%, P <0.00001). It exhibits comparable efficacy across various surgical procedures, as evidenced by its RR of 0.25 [95% CI 0.15-0.41], I2 =51%, and P <0.0001 for general surgery, RR=0.47 [95% CI 0.32-0.67], I2 =82%, P =0.0002 for cesarean section and RR of 0.47 [95% CI 0.34-0.65], I2 =76% and P <0.00001 for additional surgical procedures, including neurosurgery, orthopedic surgery, etc.
Conclusion: This meta-analysis suggests using either 2.0-2.5% chlorhexidine in alcohol instead of aqueous, alcoholic iodine to prevent SSIs in adult patients undergoing surgery. Chlorhexidine in alcohol worked effectively for general surgery, cesarean sections, and other surgeries. Thus, preoperative skin cleansing with chlorhexidine-alcohol minimizes postoperative SSIs and bacterial colonization in diverse procedures.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

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R4KO0DY52L (Chlorhexidine)
0 (Anti-Infective Agents, Local)
9679TC07X4 (Iodine)
0 (Alcohols)

Date Created: 20240821 Date Completed: 20241219 Latest Revision: 20250103

20250104

PMC11573111

10.1097/JS9.0000000000002024

39166941