JAMA

Povidone iodine vs. chlorhexidine gluconate: How do they stack up as pre-op antiseptics?

June 25, 2024

Povidone iodine in alcohol as preoperative skin antisepsis was noninferior to chlorhexidine gluconate in alcohol in preventing surgical site infections (SSIs) after cardiac or abdominal surgery.

• This multicenter, cluster-randomized, investigator-masked, crossover trial enrolled 3,360 patients undergoing cardiac or abdominal surgery in 3 tertiary care hospitals in Switzerland between September 2018 and March 2020. A total of 1,598 patients were randomly assigned to receive povidone iodine vs. 1,762 patients to chlorhexidine gluconate over 18 consecutive months.
• SSIs were identified in 80 patients (5.1%) in the povidone iodine group vs. 97 (5.5%) in the chlorhexidine gluconate group, a difference of 0.4% (95% CI, -1.1% to 2.0%) with the lower limit of the CI not exceeding the predefined noninferiority margin of -2.5%. The unadjusted relative risk for povidone iodine vs. chlorhexidine gluconate was 0.92 (95% CI, 0.69 to 1.23).
• For cardiac surgery, the rate of SSIs was 4.2% in the povidone iodine group vs. 3.3% in the chlorhexidine gluconate group (relative risk, 1.26; 95% CI, 0.82 to 1.94). For abdominal surgery, the rate of SSIs was 6.8% in the povidone iodine group vs. 9.9% in the chlorhexidine gluconate group (relative risk, 0.69; 95% CI, 0.46 to 1.02).

Source:

Widmer AF, et al. (2024, June 17). JAMA. Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/38884982/