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.

Abstract

<h4>Background</h4>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.<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.