Antiseptic Synthesis of Evidence 1

Antiseptic Synthesis of Evidence

Abbey Miller

College of Nursing, Auburn University

NURS 4920: Evidence Based Practice for Nursing

Dr. Katilya Ware & Dr. William S. Pope

April 14, 2023

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Abstract

The purpose of this professional paper is to explore chlorhexidine gluconate and povidone-iodine

antiseptics in the rate of surgical site infection (SSI). SSIs increase the rate of morbidity and mortality, as

well as length of hospital stay and cost. Before a surgery, an antiseptic should be used on the surgical

site, and continued to be used for maintenance of care. The studies used focused on central venous

catheter sites and shoulder regions, in addition to clean surgeries as a whole. After analyzing each study,

all, with the exception of the shoulder region, determined that chlorhexidine gluconate was more

effective in the prevention of SSIs.

Keywords: Infection, Antiseptic, Chlorhexidine gluconate, Povidone-iodine

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Antiseptic Synthesis of Evidence

Introduction

SSIs are one of the most frequent causes of healthcare associated infections. While doing a

surgical procedure in nursing, it is important to properly prepare the clients skin to reduce the likeliness of

infection. In this paper, studies will be observed in order to compare the efficiency of skin preparation

with chlorhexidine gluconate compared to povidone-iodine and the rates of SSI. If the most efficient

antiseptic is not used to prepare skin in surgeries, clients will be susceptible to infection. Infection

prolongs time spent in the hospital, as well as negatively influences the overall outcome. The results of

these studies contribute to provide evidence for best practice used in healthcare to protect clients.

Central Venous Catheter

The first surgical site assessed for this paper is for central venous catheter (CVC) care through a

meta-analysis (Shi et al., 2019). CVCs are commonly used in the hospital with critical clients, and if a

client develops a catheter-related bloodstream infection (CRBSI) the morbidity and mortality of the client

will be greatly increased. The efficiency of chlorhexidine gluconate was compared with povidone iodine

in a randomized controlled trial study, during both insertion of the catheter and continued cleaning. The

findings concluded that a chlorhexidine gluconate solution was more effective than a povidone iodine

solution for CVC care, as chlorhexidine gluconate’s antimicrobial activity can last longer (Shi et al.,

2019).

Cesarean Delivery

10 randomized controlled trials (RCT) evaluated the effect vaginal cleansing prior to cesarean

delivery had on postcesarean infection and morbidity (Lakhi et al., 2019). Participants were pregnant

women in non-emergent cesarean deliveries that were randomly prepared for surgery using either

chlorhexidine gluconate or povidone iodine. Although some aspects such as clients with pregestational

diabetes or early membrane rupture altered the risk of infection, overall, the risk for infection was
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significantly lower when chlorhexidine gluconate was used in vaginal cleansing in comparison to

povidone-iodine (Lakhi et al., 2019).

Shoulder Region

In a study done over the comparison of povidone iodine verses chlorhexidine gluconate in the

shoulder region, flora of the client’s skin was considered one of the most important factors of SSI (Dörfel,

et al., 2021). The study was a randomized crossover design using chlorhexidine gluconate or povidone

iodine, and assessed whether the flora of the skin was aerobic or anaerobic. In both cases, povidone

iodine proved to be superior to chlorhexidine gluconate, with a greater significance with anaerobic flora

(Dörfel, et al., 2021).

Clean Surgeries

Clean surgeries are defined as surgery in the absence of infection and inflammation. In a

systematic review and network meta-analysis posted in the Annals of Surgery, 17 articles were utilized in

which they compared the effectiveness of chlorhexidine gluconate and povidone iodine when used in

clean surgeries (Wade et al., 2020). After analyzing the study, evidence concluded a reduced risk of SSIs

when chlorhexidine gluconate was used in comparison to iodine povidone. As stated before, SSIs lead to

a greater risk of morbidity and mortality, therefore assuring a surgical site is properly cleaned before and

after surgery is vital to the wellbeing of clients (Wade et al., 2020).

Conclusion

In each article, excluding Dörfel, et al. (2021), used for this synthesis of evidence,

chlorhexidine gluconate antiseptic used for skin preparation resulted in less surgical site infections

compared to povidone-iodine. Following evidenced based practice and using the most efficient antiseptic

for the specified area is key to prevent SSIs, however other methods include strict hand hygiene,

antibiotic prophylaxis, and removing hair from the operative site if necessary. More research needs to be
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done on specific surgical sites to determine the most efficient antiseptic for each location. Teaching needs

to be done to ensure healthcare workers are knowledgeable about up-to-date research and compliance

should be observed. SSIs are one of the most frequent causes of hospital-acquired-infections and proper

protocols can greatly reduce occurrence and severity of infection.

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References

Dörfel, D., Maiwald, M., et al. (2021). Comparison of the antimicrobial efficacy of povidone-iodine

alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic

skin flora of the shoulder region. Antimicrobial Resistance and Infection Control, 10 (17). 

https://doi.org/10.1186/s13756-020-00874-8

Lakhi, A, N., Tricorico, G, BS., Osipova, Y, DO., & Moretti, L, M, MD. (2019). Vaginal cleansing with

chlorhexidine gluconate or povidone iodine prior to cesarean delivery: A randomized

comparator- controlled trial. American Journal of Obstetrics & Gynecology, 1, 1.

https://doi.org/10.1016/j.ajogmf.2019.03.004

Shi, Y., Yang, N., Zhang, L., Zhang, M., Pei, H.- H., & Wang, H. (2019). Chlorhexidine disinfectant can

reduce the risk of central venous catheter infection compared with povidone: a meta-analysis.

American Journal of Infection Control, 47(10), 1255–1262.

https://doi-org.spot.lib.auburn.edu/10.1016/j.ajic.2019.02.024

Wade, R. G., Burr, N. E., McCauley, G., Bourke, G., & Efthimiou, O. (2020). The comparative efficacy of

chlorhexidine gluconate and povidone-iodine antiseptics for the prevention of infection in clean

surgery. Annals of Surgery, 274(6). https://doi.org/10.1097/sla.0000000000004076

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