Abstract
Objective To compare chlorhexidine–alcohol with povidone–iodine solutions for skin antisepsis
prior to cesarean delivery for the prevention of surgical site infection.
Study Design Electronic databases MEDLINE, Embase, Scopus, and Clinicaltrials.gov were searched
from inception to August 2017. Eligible studies included randomized controlled trials
comparing chlorhexidine–alcohol with povidone–iodine skin preparation solutions for
women undergoing cesarean delivery. The primary outcome was surgical site infection
including superficial or deep wound infection. Meta-analysis was performed, and risk
ratios (RRs) with 95% confidence interval (CI) were calculated using the Mantel–Haenszel
random effects model. Statistical heterogeneity was assessed using Higgin's I
2.
Results Of 61 abstracts identified in the primary search, four studies (3,059 women) met
the eligibility criteria. The risk of surgical site infection was significantly reduced
with chlorhexidine–alcohol (RR: 0.72; 95% CI: 0.52–0.98). No heterogeneity across
studies was observed with I
2 = 0%. Subgroup analysis of superficial infection only or deep infection only showed
no statistically significant difference (RR: 0.76, 95% CI: 0.54–1.08; and RR: 0.50,
95% CI: 0.23–1.10, respectively).
Conclusion Preoperative skin cleansing prior to cesarean delivery with chlorhexidine–alcohol
reduces surgical site infection as compared with povidone–iodine solutions.
Keywords
cesarean delivery - surgical site infection - skin antisepsis - chlorhexidine
