Abstract

THE COMPARATIVE EFFICACY OF CHLORHEXIDINE GLUCONATE AND POVIDONE-IODINE FOR THE PREVENTION OF INFECTION IN SURGERY

*Dr. Shanza Nasir, Dr. Maham Nasir and Dr. Sana Khalid

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Abstract

Objective: There is uncertainty around preoperative skin antisepsis in clean surgery. Network meta-analysis provides more precise estimates than standard pairwise meta-analysis and can rank interventions by efficacy, to better inform clinical decisions. Background: Infection is the most common and costly complication of surgery. The relative efficacy of CHG and PVI based skin antiseptics in clean surgery remains unclear. Methods: We searched for randomized or nonrandomized studies comparing the effect of different preparations of CHG and PVI on the dichotomous outcome of surgical site infection. We included studies of adults undergoing clean surgery. We excluded studies concerning indwelling vascular catheters, blood sampling, combination antiseptics or sequential applications of different antiseptics. We performed a network meta-analysis to estimate the relative efficacy of interventions using relative risks (RR). Results: We included 17 studies comparing 5 antiseptics in 14,593 individuals. The overall rate of surgical site infection was 3%. Alcoholic CHG 4%– 5% was ranked as the most effective antiseptic as it halved the risk of surgical site infection when compared to aqueous PVI [RR 0.49 (95% confidence interval 0.24, 1.02)] and also to alcoholic PVI, although uncertainty was larger [RR 0.51 (95% confidence interval 0.21, 1.27)]. Adverse events related to antiseptic application were only observed with patients exposed to PVI. Conclusions: Alcoholic formulations of 4%–5% CHG seem to be safe and twiceaseffectiveas PVI (alcoholicoraqueoussolutions) inpreventinginfection after clean surgery in adults. Our findings concur with the literature on From Holy Family Hospital, Rawalpindi. Ethical review was not required as this is a review of published literature. contaminated and clean-contaminated surgery, and endorse guidelines world wide which advocate the use of alcoholic CHG for preoperative skin antisepsis. Registration: PROSPERO ID CRD42018113001.

Keywords: antisepsis, antiseptics, chlorhexidine gluconate, infection, meta analysis, network, povidone-iodine, skin prep, surgery.