title: Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis.
abstract: BACKGROUND
  Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions.
  
  
  OBJECTIVE
  To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates.
  
  
  METHODS
  We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization.
  
  
  RESULTS
  Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95% CI, 0.36-0.55).
  
  
  CONCLUSIONS
  There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery.
authors.affiliation: Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy. Electronic address: gaetano.privitera@med.unipi.it.
authors.forename: Gaetano Pierpaolo
authors.initials: GP
authors.lastname: Privitera
authors.affiliation: Università di Pisa, Pisa, Italy.
authors.forename: Anna Laura
authors.initials: AL
authors.lastname: Costa
authors.affiliation: Dipartimento di Scienze Mediche e Biologiche, Università di Udine, Udine, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Brusaferro
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università degli Studi di Roma La Sapienza, Rome, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Chirletti
authors.affiliation: S.C. Farmacia Laboratorio Galenici-Sperimentazioni Cliniche-Farmacovigilanza e Diagnostici, Az. Ospedaliera Città della Salute e della Scienza, Torino, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Crosasso
authors.affiliation: Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Massimetti
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università degli Studi di Milano Bicocca, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nespoli
authors.affiliation: Dipartimento Clinico e di Ricerca in Malattie Infettive, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani", IRCCS, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
authors.affiliation: Dipartimento di Scienze Chirurgiche, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pittiruti
authors.affiliation: Unità di Consulenza Infettivologica Integrata, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Scoppettuolo
authors.affiliation: Unità Operativa Malattie Infettive, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tumietto
authors.affiliation: Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D000985:Antisepsis / Q000379:methods*; D002710:Chlorhexidine / Q000008:administration & dosage*; D006801:Humans; D007455:Iodine / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods*; D012867:Skin / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D007455:Iodine; D002710:Chlorhexidine
keywords: Chlorhexidine; Health care–associated infections; Iodine; Preoperative antisepsis; Surgical site infections