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Systematic Review and Cost Analysis Comparing Use of chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection

Published online by Cambridge University Press:  02 January 2015

Ingi Lee*
Affiliation:
Divisions of Infectious Diseases, Philadelphia, Pennsylvania Department of Medicine, and the Center for Evidence-based Practice, Philadelphia, Pennsylvania
Rajender K. Agarwal
Affiliation:
Department of Medicine of the John Stroger Hospital of Cook County, Chicago, Illinois
Bruce Y. Lee
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, and the Departments of Medicine, Epidemiology, and Biomedical Informatics of the University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
Neil O. Fishman
Affiliation:
Divisions of Infectious Diseases, Philadelphia, Pennsylvania
Craig A. Umscheid
Affiliation:
General Internal Medicine, Philadelphia, Pennsylvania Department of Medicine, and the Center for Evidence-based Practice, Philadelphia, Pennsylvania
*
Hospital of the University of Pennsylvania, Division of Infectious Diseases, 3400 Spruce Street, 3rd Floor, Silverstein Building, Suite E, Philadelphia, PA 19104, (ingi.lee@uphs.upenn.edu)

Abstract

Objective.

To compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost.

Methods.

We 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.

Results.

Nine 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.

Conclusions.

Preoperative skin antisepsis with chlorhexidine is more effective than preoperative skin antisepsis with iodine for preventing SSI and results in cost savings.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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Systematic Review and Cost Analysis Comparing Use of chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection
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