The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery

@article{Wade2020TheCE,
  title={The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery},
  author={Ryckie George Wade and Nicholas Ewin Burr and Gordon McCauley and Gr{\'a}inne Bourke and Orestis Efthimiou},
  journal={Annals of Surgery},
  year={2020},
  volume={274},
  pages={e481 - e488}
}
Supplemental Digital Content is available in the text 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… 

Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis.

A frequentist random effects network meta-analysis to estimate the network effects of the skin preparation solutions on the prevention of SSIs found the efficacy of olanexidine was established by a single randomised trial and further investigation is needed.

Bacterial Sensitivity to Chlorhexidine and Povidone-Iodine Antiseptics Over Time: A Systematic Review and Meta-Analysis of Human-Derived Data

There is no evidence of change in susceptibility of common SSI-causing microbes to CHX over time, providing reassurance that the worldwide guidance that CHX should remain the first-choice agent for skin asepsis prior to surgery.

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR): an international multicentre prospective cohort study

The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery and for emergency upper limb surgery.

Effectiveness of chlorhexidine in preventing infections among patients undergoing cardiac surgeries: a meta-analysis and systematic review

In patients undergoing cardiac surgery, CHX does not protect againstSSI, deep wound infection, and urinary tract infections but might protect against superficial SSI, bloodstream infection, nosocomial infections, and pneumonia.

Preoperative Intranasal Decolonization with Topical Povidone-Iodine Antiseptic and the Incidence of Surgical Site Infection: A Review

The role of preoperative intranasal decolonization with topical povidone-iodine antiseptic in the incidence of SSI is discussed based on a review of the literature and further large-scale controlled clinical studies are needed before proper guidelines can be made.

Preoperative skin antisepsis in hand surgery: a nationwide survey

A network meta-analysis addressed a void in the literature concerning antiseptics in clean surgery and showed that alcoholic CHG halves the risk of surgical site infection compared with any formulation of povidone-iodine.

Pragmatic randomized trial evaluating pre-operative aqueous antiseptic skin solution in open fractures (Aqueous-PREP): the feasibility of a cluster randomized crossover study

The results confirm the feasibility of a definitive study comparing antiseptic solutions using a cluster randomized crossover trial design and accurate documentation of the primary outcome (surgical site infection).

Perioperative Interventions to Reduce Surgical Site Infections: A Review.

Study results do not show that irrigating clean wounds with crystalloid solutions containing antibiotics or routinely using plastic drapes with or without impregnated iodophor or silver nylon-impregnated dressings significantly reduces SSI incidence.

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