Povidone Iodine versus Chlorhexidine in Skin Antisepsis before Elective Plastic Surgery Procedures: A Randomized Controlled Trial

The Importance of Isopropyl Alcohol in Skin Preparation Solutions

“…In the Saltzman et al 3 and Ostrander et al 4 studies, there were fewer positive skin swab cultures in the chlorhexidine group, but the SSI rates were not significantly different between the two groups. Only in the study by Veiga et al 5 were they able to show a decrease in SSI rates in the chlorhexidine group. With the exception of the studies by Culligan et al 6 (which compared 2 non-IPA-containing solutions) and Berry et al 5 (which contained a chlorhexidineplus-spirits solution), all of the other studies compared chlorhexidine plus IPA with iodophore agents that did not contain alcohol.…”

“…Only in the study by Veiga et al 5 were they able to show a decrease in SSI rates in the chlorhexidine group. With the exception of the studies by Culligan et al 6 (which compared 2 non-IPA-containing solutions) and Berry et al 5 (which contained a chlorhexidineplus-spirits solution), all of the other studies compared chlorhexidine plus IPA with iodophore agents that did not contain alcohol. We do not believe that this is a valid comparison.…”

“…Furthermore, when examining the studies used in the systematic review by Lee et al, 1 we see that the authors found only 3 studies (Saltzman et al, 3 Ostrander et al," and Veiga et al 5 ) that compared iodophore solutions that contain alcohol with chlorhexidine solutions that contain alcohol. In these studies, the outcomes measured were positive skin swab cultures and/or SSIs.…”

“…4 The meta-analysis reported no significant difference between iodine-alcohol and aqueous iodine in decreasing SSI rates. 4 Additionally, the meta-analysis included the study by Berry et al 5 that found that chlorhexidine 0.5% in alcohol was more effective than povidone-iodine 10% in alcohol in preventing SSIs. In summary, the results from these studies conflict with the hypothesis that alcohol is the primary active agent in antiseptic formulations with alcohol.…”

Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis

“…13,[20][21][22][23][24] Two trials reported on patients who had a clean surgery, 20,21 three trials included patients underwent clean contaminated surgery, 13,22,23 and one trial on mixed surgery patients (clean, clean contaminated, and contaminated surgery) as shown in Table 2. 24 The experiment group used chlorhexidine scrub and/or paint in varying concentrations (from 0.5% to 4%) with a mixture or addition of 70% isoprophyl-alcohol.…”