Preoperative Chlorhexidine Wash Superior to Povidone-Iodine

Daniel M. Keller, PhD

September 30, 2011

September 30, 2011 (Chicago, Illinois) — Using chlorhexidine as a preoperative surgical wash cut the risk for a surgical site infection (SSI) in half, compared with washing with 10% povidone-iodine, investigators from the Singapore General Hospital reported here at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy.

Chlorhexidine and povidone-iodine, both used preoperatively to reduce SSIs, have similar spectra of bactericidal activity, but differences in their effectiveness in eradicating microbes have been reported. Investigators, led by pharmacist Yixin Liew, performed a meta-analysis to evaluate the effectiveness of a chlorhexidine bath in reducing the rate of SSIs.

They searched electronic databases for randomized controlled trials, published before May 2010, in which preoperative chlorhexidine baths or scrubs were compared with placebo or other antiseptic washes. Trials that reported outcomes of SSIs and/or adverse events were included. Ten studies involving 10,934 patients met the eligibility criteria and were included in the meta-analysis.

The authors report that preoperative chlorhexidine reduced the rate of SSIs by half, compared with 10% povidone-iodine (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37 to 0.80; P = .002).

Chlorhexidine did not show a statistically significant reduction in SSIs caused by Gram-positive organisms, compared with bathing with soap (OR, 0.53; 95% CI, 0.37 to 0.78; P = .15).

The most common treatment-related adverse events associated with the use of any of the preoperative preparations were erythema and pruritus, but there were no significant differences in any of the treatment groups on these measures.

David Hooper, MD, chief of the infection control unit and associate chief of the infectious disease division at Massachusetts General Hospital in Boston, and president of the American Society of Microbiology, told Medscape Medical News that this study is in line with "data in a number of realms...that say that chlorhexidine, perhaps because of its ability to bind to squamous epithelial cells, and so have a residual effect, is more effective" for presurgical bathing and as a surgical skin prep as well.

He said his hospital has moved to chlorhexidine as the preferred surgical scrub, "and there are recommendations as part of guidelines that you should consider that."

Ms. Liew and Dr. Hooper have disclosed no relevant financial relationships.

51st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Abstract K-480. Presented September 18, 2011.

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