Comparing the efficacy of chlorhexidine and povidone-iodine for surgical site disinfection: a systematic review and meta-analysis from randomized controlled trials.
Lei Wang, Shenghao Xu, Qibo Xu et al.
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In 30 seconds
This systematic review and meta-analysis of randomized controlled trials compared preoperative chlorhexidine (CH) with povidone-iodine (PVI) for surgical skin disinfection. Across 26 studies involving 29,356 participants, CH was associated with fewer overall surgical site infections: 7.1% (1,045/14,677) versus 7.8% (1,152/14,679) with PVI (RR: 0.89; 95% CI: 0.80 to 0.99). The absolute risk reduction was 0.7%, with a number needed to treat of 143. CH also reduced superficial infections, but no significant differences were found for deep or organ/space infections or secondary outcomes.
Key findings
- Overall SSI occurred in 7.1% with CH versus 7.8% with PVI (RR: 0.89; 95% CI: 0.80 to 0.99).
- Superficial SSI was lower with CH (RR: 0.77; 95% CI: 0.64 to 0.92; 13 studies, n = 16,867).
- No significant difference was found for deep SSI (RR: 1.00; 95% CI: 0.77 to 1.29) or organ SSI (RR: 1.17; 95% CI: 0.89 to 1.53).
- Hospital stay, readmission, and reoperation rates did not differ significantly between groups.
Why it matters
The pooled randomized-trial evidence suggests CH may modestly reduce overall and superficial surgical site infections compared with PVI. The absolute reduction was small, and the analysis found no advantage for deeper infection categories or the reported secondary outcomes. These distinctions help frame the potential benefit without overstating its clinical magnitude.
What to keep in mind
The abstract does not report heterogeneity or risk-of-bias assessments, limiting appraisal of consistency and certainty across the included trials.