Santos Ana Clara Felix de Farias, Zamora Fernanda Valeriano, Galvao Lorhayne Kerly Capuchinho Scalioni, Pimenta Nicole Dos Santos, Cavalcante Deivyd Vieira Silva, Salles João Pedro Costa Esteves Almuinha, Hira Sara, Zamora Andres Villca
Department of Pharmacy, City University of São Paulo, São Paulo, Brazil.
Department of Medicine, Federal University of Minas Gerais,Belo Horizonte, Brazil.
J Hosp Infect. 2024 Sep 21. doi: 10.1016/j.jhin.2024.09.005.
Surgical site infection (SSI) remains a challenge in healthcare, contributing to prolonged hospital stays, increased healthcare costs, and adverse patient outcomes, including mortality. Effective preoperative skin disinfection interventions, such as povidone-iodine (PVI) and chlorhexidine (CHG), are widely used but their efficacy remains debated. To address this gap, this meta-analysis aims to evaluate the efficacy of PVI and CHG.
We searched PubMed, Embase, and Cochrane databases up to June 2024 to identify studies comparing PVI versus CHG for preoperative skin antisepsis. We calculated odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CIs). A random-effects model was used with statistical significance set at p < 0.05. Data were analysed using R software (version 4.4.0), and heterogeneity was assessed using I statistics.
Sixteen randomised controlled trials (RCTs) were included, involving a total of 13,721 patients, among whom 6,836 (49.8%) received PVI. Compared to CHG, PVI was associated with a non-significant reduction in deep SSI (OR 1.00; 95% CI 0.66 - 1.50; p = 0.994), but an increased risk of overall SSI (OR 1.25; 95% CI 1.06 - 1.48; p = 0.007) and superficial SSI (OR 1.67; 95% CI 1.25 - 2.24; p < 0.001).
PVI as preoperative skin antisepsis demonstrated a non-significant reduction in deep SSI compared to CHG but was associated with an increased risk of overall and superficial SSI. Despite these findings, PVI remains an effective option, especially in resource-limited settings. Further research is needed to optimise its use and improve infection prevention strategies in clinical practice.
