Table 1.
Study | Study design | Country, time interval | CHG (concentration, solution) (%) | PVP-I (concentration, solution) (%) | Reported outcome | Skin washing before use of the two antiseptics | Observation interval |
Definition of SSI | |
---|---|---|---|---|---|---|---|---|---|
CHG | PVP-I | ||||||||
Berry 198224 | Prospective, randomized study | England, 1978–1980 | 0.5, 70 isopropyl alcohol | A: 10, alcohol B: 7.5, N/A | Wound infection | Two applications with sterile sponges | 3 to 4 days | N/A | |
Brown 198425 | Prospectively randomized study | India, 1979–1980 | 0.5, 70 isopropyl alcohol | 7.5, N/A | Wound infection | Removal of obvious foreign material present with a clean sponge followed by a spray application of 0.5% CHG in 70% isopropyl alcohol | 6 min scrub with PVP-I soap, then painted with aqueous PVP-I solution that absorbed with a sterile towel | N/A | A minor wound infection: an infected wound with superficial, separation (less than 1 cm) involving less than one-third of the incision or induration of the wound edge believed by the surgeon to be secondary to infection. A major wound infection: an infected wound with separation of the wound edges greater than one-third of the length of the incision or frank wound infection with evidence of purulent exudate or abscess. |
Veiga 200826 | RCT | Brazil, N/A | 0.5, alcohol | 10, alcohol | Postoperative infection | A vigorous scrub with antiseptic soap, followed by absorption with a sterile towel and painting | 30 days | The CDC definitions and classification of surgical site infections | |
Cheng 200927 | Prospective randomized study | England, 2007–2008 | 0.5, 70 isopropyl alcohol | 10, 23 isopropyl alcohol | Postoperative infections or wound complications |
Scrubbed with a sterile surgical bristled brush for 3 min and then painted | N/A | N/A | |
Paocharoen 200928 | Prospective randomized trial | Thailand, 2006–2008 | 4, 70 isopropyl alcohol | N/A, N/A | Postoperative surgical wound infection | 5 min scrubbing, then paint | 1 month | If a surgical wound drained purulent material or if the surgeon judges it to be infected and opens it | |
Sistla 201029 | Prospective randomized trial | India, N/A | 2.5, 70 ethanol | 10, N/A | SSI | Applied in concentric circles beginning from the site of incision to the periphery and allowed to dry before the surgical site was draped | 30 days | The CDC criteria | |
Rodrigues 201330 | Randomized, longitudinal study | Brazil, 2011 | 0.5, alcohol | 10, hydro alcohol | SSI | The skin was prepared in the same manner as it was for the PVP-I group; however, the cleaning was carried out with water and 20 ml 2% CHG soap, and complementation with 0.5% alcoholic CHG | After hand hygiene and gloving, with a compress soaked in water and 20 ml PVP-I, the area was vigorously rubbed for 5 min. The area was then cleaned with another sterile compress. The preparation was completed by marking the operative area with 10% hydroalcoholic PVP-I | N/A | The presence of at least one of the following signs: fever, without other apparent cause, pain, heat, swelling, or confluent erythema around the incision and extrapolating the boundaries of the wound, pus in the incision site or in the deep soft tissue, or in organ/cavity handled during operation; presence of abscesses or, in the case of deep tissues, histological or radiological evidence suggestive of infection; isolated microorganism from theoretically sterile source or harvested with aseptic technique from a previously closed site, and spontaneous dehiscence of deep tissues |
Perek 201331 | Randomized clinical study | Poland, 2011 | N/A, 70 ethanol | N/A, 50 propyl alcohol | SSI | Had a shower and a bath with CHG soap on the day before surgery, then disinfected twice | 30 days | CDC guidelines | |
Ngai 201533 | RCT | USA, 2013–2014 | N/A, alcohol | N/A, alcohol | SSI | CHG with alcohol | PVP-I with alcohol | 30 days | According to Horan et al. 1992 and the CDC |
Srinivas 201532 | RCT | India, 2011–2012 | 0.5, 70 isopropyl alcohol | 5, N/A | SSI | Painted 3 times, around the site of the incision | Painted with 5% PVI-I solution three times | 30 days | CDC criteria |
Salama 201634 | RCT | Egypt, 2014 | 2, 70 alcohol | 10, 70 alcohol | SSI | 3 applications of 2% CHG followed by drying with a sterile towel after 30 and 3 applications of 70% alcohol |
Scrubbed that contained 10% PVP-I, followed by drying with a sterile towel after 1 min and 3 applications of 10% PVP-I in 70% alcohol |
30 days | Defined by pain, tenderness, swelling, redness, heat, purulent discharge from the incision, or deliberate reopening of the surgical wound |
Springel 201735 | RCT | USA, 2014–2016 | 2, 70 isopropyl alcohol | 10, aqueous | SSI | Paint | 0.75% PVP-I aqueous scrub followed by 1.0% PVP-I aqueous paint | N/A | US National Healthcare Safety Network, CDC definitions |
Kesani 201936 | Randomized prospective study | N/A, 2017 | 2, 70 isopropyl alcohol | 10, surgical spirit | SSI | Before operation, scrubbed at the surgical site by either the CHG–alcohol (2% CHG and 70% isopropyl alcohol) | Before operation, scrubbed at the surgical site by either the PVP-I (10% PVP-I and then with surgical spirit) | 30 days | CDC definitions |
Ritter 201937 | Prospective randomized trial | N/A, 2014–2015 | 2, 70 isopropyl alcohol | 1, 50 2-propanol | SSI | ChloraPrep (2% CHG and 70% isopropyl alcohol) (CareFusion; Leawood, Kansas, USA) | Braunoderm (1% PVP-I and 50% 2-propanol) (B. Braun Medical AG; Melsungen, Germany) | 6 months | Established criteria published by the CDC and the following additional criteria: (1) necessity of antibiotic therapy, (2) necessity of surgical intervention, and (3) positive microbiologic culture of swabs taken intraoperatively |
Gezer 202038 | RCT | Turkey, 2017–2019 | 4, alcohol | N/A, N/A |
SSI | Habitanol 1000 ml solution (Kimpa Drugs, İstanbul, Turkey) | Poviderm 1000 ml solution (Necm Chemistry, İstanbul, Turkey) | 30 days | CDC definition |
N/A, not available; CHG, chlorhexidine gluconate; PVP-I, povidone-iodine; RCT, randomized clinical trial; SSI, surgical site infection; CDC, Centers for Disease Control and Prevention.