BACKGROUND: The comparative effectiveness of chlorhexidine gluconate (CHG) versus povidone-iodine (PVI) for preventing surgical site infections (SSIs) remains unclear across surgical types and resource settings. This study compared CHG and PVI overall and within key clinical subgroups. METHODS: Five databases were searched through February 2025 for randomized controlled trials comparing CHG with PVI and reporting SSI outcomes. Random-effects models generated pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: = 18.4%), but not overall, deep, or organ/space infections; meta-regression indicated that patient age was a significant effect modifier. In cesarean sections, CHG lowered overall (OR = 0.64; 95% CI 0.48-0.85), superficial (OR = 0.65; 95% CI 0.48-0.87), and deep incisional SSIs (OR = 0.41; 95% CI 0.22-0.75). In abdominal surgery, CHG reduced only superficial incisional SSIs (OR = 0.68; 95% CI 0.52-0.91). No significant differences were observed in gynecologic, cardiothoracic, or orthopedic procedures. By wound classification, CHG had no effect in clean surgery but reduced superficial incisional SSIs in clean-contaminated cases (OR = 0.65; 95% CI 0.48-0.89). By income level, no differences were seen in high-income countries, while in low- and middle-income countries CHG decreased overall (OR = 0.58; 95% CI 0.46-0.74), superficial (OR = 0.54; 95% CI 0.38-0.76), and deep incisional SSIs (OR = 0.48; 95% CI 0.25-0.92). CONCLUSION: Alcohol-based CHG and alcohol-based PVI are comparably effective in most surgical settings. However, CHG demonstrates superior prevention of SSIs in cesarean, abdominal, and clean-contaminated surgeries, with the most substantial benefit in low- and middle-income settings. Broader use may be justified pending cost-effectiveness evaluation.
Benhammou et al. (Thu,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: