Abstract
Preoperative skin preparation is an effective method to prevent surgical site infections (SSI). Alcoholic chlorhexidine (CHG) and povidone iodine (PV-I) are the most widely used antiseptic agents. This meta-analysis aims to determine their efficacy in reducing natural bacterial skin flora in clean orthopedic surgery. A systematic search was conducted through current literature up to June 2021 to identify clinical randomized trials that compared the efficacy of alcoholic chlorhexidine and povidone iodine in reducing bacterial skin colonization after preoperative skin preparation. A meta-analysis was conducted. Of 235 screened articles, 8 randomized controlled trials were included. The results of the meta-analysis demonstrate a significantly lower positive culture rate in the chlorhexidine group than in the povidone iodine group (RR = 0.53, 95% Cl: 0.32–0.88). The present data show the superiority of chlorhexidine in reducing the normal bacterial flora compared to povidone iodine in clean orthopedic surgery.
Highlights
Preoperative skin preparation is an effective method to prevent surgical site infections (SSI)
The concentration and exposure time have been established as a compromise between tissue toxicity and practicability of the different antiseptic agents in order to achieve a minimum of tissue toxicity and a short exposure time with a maximum reduction of the normal skin flora
Studies were considered eligible if they met all of the following criteria: 1. published clinical randomized controlled trial (Level I study) 2. the experimental group received alcoholic chlorhexidine solution for preoperative skin preparation and the control group received a standard preoperative skin preparation with povidone iodine solution without alcohol and 3. the outcome was the measurement of bacterial colonization as a positive bacterial culture directly after skin preparation
Summary
Preoperative skin preparation is an effective method to prevent surgical site infections (SSI). Alcoholic chlorhexidine (CHG) and povidone iodine (PV-I) are the most widely used antiseptic agents This metaanalysis aims to determine their efficacy in reducing natural bacterial skin flora in clean orthopedic surgery. A systematic search was conducted through current literature up to June 2021 to identify clinical randomized trials that compared the efficacy of alcoholic chlorhexidine and povidone iodine in reducing bacterial skin colonization after preoperative skin preparation. The present data show the superiority of chlorhexidine in reducing the normal bacterial flora compared to povidone iodine in clean orthopedic surgery. By screening and analyzing the current orthopedic literature, the objective of this study was to determine the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in reducing the natural bacterial skin flora
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