A comparison of the use of povidone-iodine and chlorhexidine in the prophylaxis of postoperative wound infection

Berry, A. R.; Watt, B.; Goldacre, M J; Thomson, J.W.W.; McNair, T.J.

doi:10.1016/0195-6701(82)90031-7

Cited by 71 publications

(58 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9,18,19 Two other trials found nonsignificant decreases in the number of SSIs with chlorhexidine use, 21,25 1 trial found a nonsignificant increase in the number of SSIs, 23 and 1 trial reported no SSIs in either study group. 20 We found no evidence of publication bias for the outcome of SSI, on the basis of visual inspection of funnel plots (Figure 2), the Egger method ( P = .99), and the Begg method ( P = .43).…”

Section: Resultsmentioning

confidence: 98%

“…The one systematic review identified in the Cochrane Library, 17 which evaluated the effect of skin antiseptics in clean surgeries, was excluded because only 1 of the 7 RCTs included in that review evaluated use of chlorhexidine; that RCT 18 was also included in our systematic review. No additional trials were identified after reviewing the reference lists of the included RCTs.…”

Section: Resultsmentioning

confidence: 99%

“…9,18-25 Five trials reported on patients who had undergone a single type of surgery, 20-24 and 4 studies included a mix of surgical patients. 9,18,19,25 The intervention group used chlorhexidine scrub and/or paint in varying concentrations (from 0.5% to 4%) with or without alcohol in all but 1 study, which evaluated a spray of chlorhexidine in IPA. The comparison group used povidone-iodine or iodophor scrub and/or paint in varying concentrations (from 0.7% to 10%) with or without alcohol.…”

Section: Resultsmentioning

confidence: 99%

“…The comparison group used povidone-iodine or iodophor scrub and/or paint in varying concentrations (from 0.7% to 10%) with or without alcohol. Four trials only reported results with respect to SSI, 9,18,21,25 2 trials only reported on positive skin culture results, 22,24 and 3 trials reported on both SSI and positive skin culture results. 19-23 One trial that reported positive skin culture results from multiple sampling sites was excluded from the meta-analysis for this outcome.…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Systematic Review and Cost Analysis Comparing Use of chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection

Lee

Agarwal

Lee³

et al. 2010

Infect. Control Hosp. Epidemiol.

204

145

View full text Add to dashboard Cite

Objective 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. Methods 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. Results 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. Conclusions Preoperative skin antisepsis with chlorhexidine is more effective than preoperative skin antisepsis with iodine for preventing SSI and results in cost savings.

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic Review and Cost Analysis Comparing Use of chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection

Lee

Agarwal

Lee³

et al. 2010

Infect. Control Hosp. Epidemiol.

204

145

View full text Add to dashboard Cite

show abstract

“…6 The results are intriguing, but the conclusions need to be tempered, given the inherent limitations of quasi-experimental studies, particularly the lack of random assignment and the difficulty in ascertaining whether statistical significance is due to causal association or an alternative explanation (ie, regression to the mean, maturation effects, and/or inadequate control of important confounders). 7 For this reason, our meta-analysis was limited to RCTs and, therefore, did not include Swenson et al 6 Third, they state that there is significant heterogeneity in the antiseptic formulations, surgeries, and outcomes in the RCTs included in our meta-analysis. To clarify, the purpose of our meta-analysis was to compare the efficacy of chlorhexidine-based formulations with that of iodine-based formulations in decreasing the primary outcome of interest, SSI, and the secondary outcome of interest, positive skin culture results after antisepsis.…”

Section: Reply To Maiwald Et Al and Riccio Et Almentioning

confidence: 99%