Divisions of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Infect Control Hosp Epidemiol. 2010 Dec;31(12):1219-29. doi: 10.1086/657134. Epub 2010 Oct 22.
To compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost.
We searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application. One reviewer extracted data and assessed individual study quality, quality of evidence for each outcome, and publication bias. Meta-analyses were performed using a fixed-effects model. Using results from the meta-analysis and cost data from the Hospital of the University of Pennsylvania, we developed a decision analytic cost-benefit model to compare the economic value, from the hospital perspective, of antisepsis with iodine versus antisepsis with 2 preparations of chlorhexidine (ie, 4% chlorhexidine bottle and single-use applicators of a 2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol [IPA] solution), and also performed sensitivity analyses.
Nine RCTs with a total of 3,614 patients were included in the meta-analysis. Meta-analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51-0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35-0.56]) than was iodine antisepsis. In the cost-benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of $16-$26 per surgical case and $349,904-$568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances.
Preoperative skin antisepsis with chlorhexidine is more effective than preoperative skin antisepsis with iodine for preventing SSI and results in cost savings.
比较氯己定与碘术前皮肤消毒在预防手术部位感染（SSI）方面的效果和成本。
我们在卫生保健研究和质量局网站、考科兰图书馆、医学文献分析与检索系统和 EMBASE 上搜索了截至 2010 年 1 月的合格研究。纳入的研究是系统评价、荟萃分析或比较氯己定和碘术前皮肤消毒的随机对照试验（RCT），并评估 SSI 或应用后阳性皮肤培养结果。一位评审员提取数据，并评估了各个研究的质量、每个结局的证据质量和发表偏倚。使用固定效应模型进行荟萃分析。使用荟萃分析的结果和宾夕法尼亚大学医院的成本数据，我们开发了一个决策分析成本效益模型，比较了碘与两种氯己定制剂（即 4%氯己定瓶和 2%葡萄糖酸氯己定[CHG]和 70%异丙醇[IPA]溶液的一次性应用器）的术前皮肤消毒的经济价值，并进行了敏感性分析。
共有 9 项 RCT 纳入了 3614 名患者的荟萃分析。荟萃分析显示，氯己定消毒与碘消毒相比，SSI（调整后的风险比，0.64[95%置信区间，0.51-0.80]）和阳性皮肤培养结果（调整后的风险比，0.44[95%置信区间，0.35-0.56]）显著减少。在成本效益模型的基线情况下，从碘切换到氯己定，每个手术病例可节省 16-26 美元，宾夕法尼亚大学医院每年可节省 349904-568594 美元。敏感性分析表明，在大多数情况下，仍有净成本节约。
与碘术前皮肤消毒相比，氯己定术前皮肤消毒在预防 SSI 方面更有效，且可节省成本。
