Chlorhexidine Antiseptics Superior to Povidine iodine in Preventing Surgical Site Infections: Study
A new study published in the journal of Frontiers in Medicine showed that when it comes to lowering total surgical site infections (SSIs), chlorhexidine (CHX)-based antiseptics perform better than povidone-iodine (PVI)-based solutions, particularly in clean-contaminated procedures. The most popular antiseptic drugs for preoperative skin preparation to avoid surgical site infections are povidone-iodine and chlorhexidine. The goal of this meta-analysis was to identify which agent was better at preventing SSI.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, this systematic review and meta-analysis was carried out. From the beginning until May 1, 2025, a thorough search of electronic databases (PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) was conducted to find pertinent randomized controlled trials (RCTs).
The chi-squared (Q) test and the I2 statistic were used to evaluate heterogeneity. When there was substantial heterogeneity, a random-effects model was used. Trial sequential analysis (TSA) using a random-effects model was used to assess the robustness of these findings.
There were 32 excellent RCTs with 29,748 participants. CHX was substantially more successful than PVI in avoiding SSIs, according to the pooled analysis employing a random-effects model. In clean-contaminated operations (11 RCTs; RR = 0.75, 95% CI 0.62–0.92, p = 0.004), subgroup analysis by wound classification showed that CHX was superior to PVI. However, no significant difference was seen in clean surgeries (20 RCTs; RR = 0.90, 95% CI 0.67–1.20, p = 0.46).
CHX significantly decreased the risk of superficial incisional SSIs (18 RCTs; RR = 0.82, 95% CI 0.69–0.98, p = 0.03), but not deep incisional SSIs (16 RCTs; RR = 0.95, 95% CI 0.76–1.18, p = 0.63) or organ-space SSIs (11 RCTs; RR = 1.13, 95% CI 0.89–1.42, p = 0.32). Furthermore, compared to PVI, CHX was linked to a substantially decreased incidence of febrile episodes (RR = 0.57, 95% CI 0.35–0.92, p = 0.02) and bacterial decolonization (RR = 0.38, 95% CI 0.26–0.57, p < 0.001).
Overall, particularly in clean-contaminated procedures, CHX-containing solutions were more successful than PVI-containing solutions at preventing postoperative SSIs. While skin antisepsis is crucial, effective SSI prevention packages also include additional evidence-based interventions such adequate antibiotic prophylaxis, diabetic management, maintaining normothermia, and adherence to sterile technique.
Source:
Yang, S., Li, Z., Wu, F., Sun, L., He, Y., & Wang, C. (2025). Chlorhexidine versus povidone-iodine for surgical site infection prevention: an updated meta-analysis and trial sequential analysis of randomized controlled trials. Frontiers in Medicine, 12(1641815). https://doi.org/10.3389/fmed.2025.1641815
