Skin Preparation with Chlorhexidine Versus Povidone-Iodine for the Prevention of Surgical Site Infection

Abstract

Background: Surgical site infections are common preventable postoperative complications that increase morbidity, hospital stay, readmission, and healthcare cost. Preoperative skin antisepsis is a key component of SSI prevention, but comparative evidence regarding chlorhexidine and povidone-iodine remains variable across clinical settings. Objective: To compare the effectiveness of chlorhexidine and povidone-iodine skin preparation in reducing surgical site infections among patients undergoing elective clean and clean-contaminated surgery. Methods: This prospective comparative observational study was conducted at Services Hospital Lahore among 200 adult elective surgical patients, with 100 patients prepared using chlorhexidine and 100 using povidone-iodine. Demographic, clinical, operative, and postoperative outcome data were collected using standardized forms. SSI occurrence was assessed according to CDC criteria. Group comparisons were performed using chi-square and independent-sample tests, while binary logistic regression  for age, gender, BMI, diabetes mellitus, operative duration, and ASA class. Results: SSI occurred in 5% of patients in the chlorhexidine group and 12% in the povidone-iodine group, yielding an absolute risk reduction of 7%. Chlorhexidine was independently associated with lower SSI odds after adjustment for confounders (AOR 0.44, 95% CI 0.25–0.78; p=0.005). Diabetes mellitus, higher BMI, longer operative duration, and ASA class III–IV significantly increased SSI risk. Hospital stay was shorter with chlorhexidine than povidone-iodine (4.2 ± 1.1 vs 5.6 ± 1.8 days; p=0.001). Conclusion: Chlorhexidine skin preparation was associated with reduced SSI risk and shorter hospitalization compared with povidone-iodine and should be considered within comprehensive perioperative infection-prevention protocols