SynthesisInfection control and hospital epidemiology2010
Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection.
Synthesis in Infection control and hospital epidemiology, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 69 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized, Blinded, Single Center Study to Assess the Incidence of Surgical Site Infections in Breast Cancer Surgery After Preoperative Skin Preparation With Chlorhexidine 2% in Alcohol 70% (CHLORAPREP ®) Versus 10% Povidone-iodine
Antisepsis Techniques in Orthopedic Surgical Procedures: a Comparative Study
Who cites it
69 citing papers in PubMed, 9 syntheses or guidelines pooled it, 249 citations in OpenAlex.
- Summary of the best evidence for the use of antiseptics at various surgical sites to prevent postoperative infections.Frontiers in medicine · 2025Pooled it
- Efficacy of different preoperative antiseptics in preventing a risk of surgical site infections: a systematic review and meta‑analysis of randomized controlled trials.Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques · 2024Pooled it
- Clean or Dirty? A Systematic Review of Splash Basin Use and Its Infectious Potential in Orthopaedic Surgery.The Iowa orthopaedic journal · 2022Pooled it
- Effectiveness of chlorhexidine in preventing infections among patients undergoing cardiac surgeries: a meta-analysis and systematic review.Antimicrobial resistance and infection control · 2021Pooled it
- Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery.Scientific reports · 2021Pooled it
- Driveline exit-site care protocols in patients with left ventricular assist devices: a systematic review.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2021Pooled it
- [Incidence of surgical site infections in sub-Saharan Africa: systematic review and meta-analysis].The Pan African medical journal · 2016Pooled it
- Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review.Intensive care medicine · 2012Pooled it
- Pooled it
- Trial
- Cluster-randomized crossover trial of chlorhexidine-alcoholBJS open · 2019Trial
- Randomized clinical trial of single skin sterilization with a povidone-iodine applicatorBJS open · 2019Trial
- Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2017Trial
- Prospective Randomized Trial Comparing the Efficacy of Surgical Preparation Solutions in Hand Surgery.Hand (New York, N.Y.) · 2017Trial
- Trial
- A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery.The New England journal of medicine · 2016Trial
- Trial
- Tailoring Drug Release Profiles From Electrospun Alginate Fibers Through Integration of Mesoporous Silica Nanoparticles.Advanced healthcare materials · 2026Article
- Rethinking Skin Preparation: Is Hypochlorous Acid (Clinisept+) a Safe Alternative Skin Preparation in Aesthetic Surgery?Aesthetic plastic surgery · 2026Observational
- The University of Oklahoma Inpatient Spine Protocol: optimizing surgical outcomes through standardized perioperative care.GeroScience · 2026Review
9 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveTo compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost.
methodsWe searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application. One reviewer extracted data and assessed individual study quality, quality of evidence for each outcome, and publication bias. Meta-analyses were performed using a fixed-effects model. Using results from the meta-analysis and cost data from the Hospital of the University of Pennsylvania, we developed a decision analytic cost-benefit model to compare the economic value, from the hospital perspective, of antisepsis with iodine versus antisepsis with 2 preparations of chlorhexidine (ie, 4% chlorhexidine bottle and single-use applicators of a 2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol [IPA] solution), and also performed sensitivity analyses.
resultsNine RCTs with a total of 3,614 patients were included in the meta-analysis. Meta-analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51-0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35-0.56]) than was iodine antisepsis. In the cost-benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of $16-$26 per surgical case and $349,904-$568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances.
conclusionsPreoperative skin antisepsis with chlorhexidine is more effective than preoperative skin antisepsis with iodine for preventing SSI and results in cost savings.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.