Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection

A systematic review and meta-analysis

Gaetano Pierpaolo Privitera, Anna Laura Costa, Silvio Brusaferro, Piero Chirletti, Paola Crosasso, Gabriele Massimetti, Angelo Nespoli, Nicola Petrosillo, Mauro Pittiruti, Giancarlo Scoppettuolo, Fabio Tumietto, Pierluigi Viale

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Abstract

BACKGROUND: Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions.

PURPOSE: To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates.

PROCEDURES: We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization.

RESULTS: Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95% CI, 0.36-0.55).

CONCLUSIONS: There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalAmerican Journal of Infection Control
DOIs
Publication statusE-pub ahead of print - Nov 9 2016

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Antisepsis
Surgical Wound Infection
Chlorhexidine
Iodine
Meta-Analysis
Skin
Local Anti-Infective Agents
Incidence
Iodophors
Odds Ratio
Confidence Intervals
Povidone-Iodine
Cross Infection
Language
Outcome Assessment (Health Care)

Keywords

  • Journal Article
  • Review

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Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection : A systematic review and meta-analysis. / Privitera, Gaetano Pierpaolo; Costa, Anna Laura; Brusaferro, Silvio; Chirletti, Piero; Crosasso, Paola; Massimetti, Gabriele; Nespoli, Angelo; Petrosillo, Nicola; Pittiruti, Mauro; Scoppettuolo, Giancarlo; Tumietto, Fabio; Viale, Pierluigi.

In: American Journal of Infection Control, 09.11.2016, p. 1-10.

Research output: Contribution to journalArticle

Privitera, GP, Costa, AL, Brusaferro, S, Chirletti, P, Crosasso, P, Massimetti, G, Nespoli, A, Petrosillo, N, Pittiruti, M, Scoppettuolo, G, Tumietto, F & Viale, P 2016, 'Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis', American Journal of Infection Control, pp. 1-10. https://doi.org/10.1016/j.ajic.2016.09.017
Privitera, Gaetano Pierpaolo ; Costa, Anna Laura ; Brusaferro, Silvio ; Chirletti, Piero ; Crosasso, Paola ; Massimetti, Gabriele ; Nespoli, Angelo ; Petrosillo, Nicola ; Pittiruti, Mauro ; Scoppettuolo, Giancarlo ; Tumietto, Fabio ; Viale, Pierluigi. / Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection : A systematic review and meta-analysis. In: American Journal of Infection Control. 2016 ; pp. 1-10.
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abstract = "BACKGROUND: Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions.PURPOSE: To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates.PROCEDURES: We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization.RESULTS: Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95{\%} confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95{\%} CI, 0.36-0.55).CONCLUSIONS: There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery.",
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T1 - Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection

T2 - A systematic review and meta-analysis

AU - Privitera, Gaetano Pierpaolo

AU - Costa, Anna Laura

AU - Brusaferro, Silvio

AU - Chirletti, Piero

AU - Crosasso, Paola

AU - Massimetti, Gabriele

AU - Nespoli, Angelo

AU - Petrosillo, Nicola

AU - Pittiruti, Mauro

AU - Scoppettuolo, Giancarlo

AU - Tumietto, Fabio

AU - Viale, Pierluigi

N1 - Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2016/11/9

Y1 - 2016/11/9

N2 - BACKGROUND: Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions.PURPOSE: To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates.PROCEDURES: We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization.RESULTS: Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95% CI, 0.36-0.55).CONCLUSIONS: There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery.

AB - BACKGROUND: Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions.PURPOSE: To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates.PROCEDURES: We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization.RESULTS: Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95% CI, 0.36-0.55).CONCLUSIONS: There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery.

KW - Journal Article

KW - Review

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DO - 10.1016/j.ajic.2016.09.017

M3 - Article

SP - 1

EP - 10

JO - American Journal of Infection Control

JF - American Journal of Infection Control

SN - 0196-6553

ER -