Efficacy of surgical skin preparation with chlorhexidine in alcohol according to the concentration required to prevent surgical site infection: meta-analysis.

Abstract

BACKGROUND:

A combination of chlorhexidine gluconate and alcohol (CHG-alcohol) is recommended for surgical skin preparation to prevent surgical site infection (SSI). Although more than 1 per cent CHG-alcohol is recommended to prevent catheter-related bloodstream infections, there is no consensus regarding the concentration of the CHG compound for the prevention of SSI.

METHODS:

A systematic review and meta-analysis was performed. Four electronic databases were searched on 5 November 2020. SSI rates were compared between CHG-alcohol and povidone-iodine (PVP-I) according to the concentration of CHG (0.5 per cent, 2.0 per cent, 2.5 per cent, and 4.0 per cent).

RESULTS:

In total, 106 of 2716 screened articles were retrieved for full-text review. The risk ratios (RRs) of SSI for 0.5 per cent (6 studies) and 2.0 per cent (4 studies) CHG-alcohol were significantly lower than those for PVP-I (RR = 0.71, 95 per cent confidence interval (c.i.) 0.52 to 0.97; RR = 0.52, 95 per cent c.i 0.31 to 0.86 respectively); however, no significant difference was observed in the compounds with a CHG concentration of more than 2.0 per cent.

CONCLUSIONS:

This meta-analysis is the first study that clarifies the usefulness of an alcohol-based CHG solution with a 0.5 per cent or higher CHG concentration for surgical skin preparation to prevent SSI.

• Authors: Tatsuki Hasegawa, Sho Tashiro, Takayuki Mihara, Junya Kon, Kazuki Sakurai, Yoko Tanaka, Takumi Morita, Yuki Enoki, Kazuaki Taguchi, Kazuaki Matsumoto, Kazuhiko Nakajima, Yoshio Takesue
• Journal: BJS open (BJS Open) Vol. 6 Issue 5 (09 02 2022) ISSN: 2474-9842 [Electronic] England
• PMID: 36124902 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

Chemical References

• Anti-Infective Agents, Local
• Ethanol
• Povidone-Iodine
• chlorhexidine gluconate
• Chlorhexidine

Topics

• Anti-Infective Agents, Local (therapeutic use)
• Chlorhexidine (analogs & derivatives, therapeutic use)
• Ethanol
• Humans
• Povidone-Iodine (therapeutic use)
• Surgical Wound Infection (prevention & control)