Pre-procedural skin antisepsis with alcoholic chlorhexidine gluconate (CHG) is twice as effective as povidone-iodine (PVI) in preventing surgical site infection (SSI), according to a new study.

Researchers at the University of Leeds (United Kingdom) and the University of Bern (Switzerland) conducted a systematic search for randomized or nonrandomized studies comparing efficacy and relative risk (RR) of different preparations of CHG and PVI on the dichotomous outcome of SSI. The studies included those of adults undergoing clean surgery, and excluded those that dealt with indwelling vascular catheters, blood sampling, a combination of different antiseptics, or in sequential applications of different antiseptics.

The results, as analyzed from 17 studies comparing five antiseptics in 14,593 patients, showed that the overall rate of SSI was 3%. Alcoholic CHG (4–5%) was ranked as the most effective antiseptic as it halved the risk of SSI when compared to both aqueous PVI (RR 0.49), and alcoholic PVI (RR 0.51), although the uncertainty was larger. Adverse events, as related to antiseptic application, were only observed with patients exposed to PVI. The study was published on September 1, 2020, in Annals of Surgery.

“This research should be of benefit to all healthcare professionals around the world who perform any type of invasive procedure on a 'clean site'. Even though the risk of infection in this type of surgery is low, anything we can change to reduce this risk is very important,” said lead author Ryckie Wade, MD, of the University of Leeds School of Medicine. “Our findings suggest that the number of infections may be halved if surgeons used a different skin cleaning agent before surgery.”

CHG is used for skin disinfection prior to surgery, sterilize surgical instruments, and disinfection of the hands of healthcare providers. CHG salts dissociate and release positively charged chlorhexidine cation molecule, which causes a bactericidal effect by binding to negatively charged bacterial cell walls. At low concentrations, a bacteriostatic effect occurs; at high concentrations, membrane disruption results in cell death. It can be applied topically as a gel, wash, or powder.

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