Preoperative skin preparation : a comparison of chlorhexidine gluconate vs povidone-iodine in preventing surgical site infections

Abstract

Overview of the topic: Surgical site infections (SSIs) are the second most common type of healthcare acquired infections (HAIs). SSIs are closely associated with additional healthcare costs, a longer hospital stay and increased mortality rates. Pre-operative skin disinfection has been shown to decrease the incidence of SSIs. Chlorhexidine gluconate (CHG) and povidoneiodine (PI) are the most used skin antiseptics, but the most effective skin antiseptic is not well-identified. The aim of this dissertation is to identify which antiseptic is more effective at preventing SSIs. The research question: Is chlorhexidine for disinfection of the operation site immediately before surgery, better than povidone-iodine in order to reduce the risk of a surgical site infection? The PICO elements: The population (P) studied was patients undergoing a surgical procedure. The intervention (I) was chlorhexidine gluconate while the comparison (C) was povidone-iodine. The final desired outcome (O) was surgical site infection. Method: The key elements of the PICO question were used to generate synonyms and alternative terms. These terms were combined using Boolean operators and truncations which were inserted in the main databases (EBSCOhost, PubMed and ProQuest Central). Other databases within these main three were used as well to generate a search. In addition, limiters were used to refine the search. A set of inclusion and exclusion criteria were developed in order to make the search more specific (Table 2.4.). The PRISMA 2009 flow diagram was used to exclude irrelevant articles. The critical appraisal skills programme (CASP) tool was used to critically appraise the literature. Results: The five final studies that were identified consisted of two systematic reviews and meta-analyses, one meta-analysis and two randomized controlled trials (RCTs). Overall, two systematic reviews and meta-analyses, one meta-analysis and one RCT revealed that CHG is more effective than PI. Only one RCT showed no significant difference. Conclusion: Evidence demonstrated that CHG in alcohol is the most effective antiseptic for the disinfection of the operative site to prevent SSIs. However, additional research is recommended to identify the right concentration at which this is most effective. Implications and recommendations: There has to be an increased awareness about SSIs and their prevention. Preventing SSIs would be beneficial for both patients and the healthcare system. Using the three P’s (posters, presentations and papers) for the dissemination of results is highly recommended since healthcare professionals (HCPs) need to be properly educated on this subject. Moreover, hospital management needs to provide updated infection control policies and make sure that the correct antiseptic is available at all times.