Povidone iodine vs chlorhexidine gluconate for pre-operative skin antisepsis: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background

Surgical site infection (SSI) remains a challenge in health care, contributing to prolonged hospital stays, increased healthcare costs, and adverse patient outcomes, including mortality. Effective pre-operative skin disinfection interventions, such as povidone iodine (PVI) and chlorhexidine (CHG), are widely used but their efficacy remains the subject of debate. To address this gap, this meta-analysis aimed to evaluate the efficacy of PVI and CHG.

Methods

PubMed, Embase and Cochrane databases were searched up to June 2024 to identify studies comparing PVI with CHG for pre-operative skin antisepsis. Odds ratios (OR) for binary outcomes with 95% confidence intervals (CI) were calculated. A random-effects model was used, with P<0.05 considered to indicate significance. Data were analysed using R Version 4.4.0, and heterogeneity was assessed using the I² statistic.

Findings: Sixteen randomized controlled trials were included, involving a total of 13,721 patients, among whom 6836 (49.8%) received PVI. Compared with 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 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).

Conclusion

PVI as pre-operative skin antisepsis demonstrated a non-significant reduction in deep SSI compared with CHG, but was associated with 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 optimize its use and improve infection prevention strategies in clinical practice.