Chlorhexidine gluconate 2% / Isopropyl alcohol 70% solution 0.67ml applicators

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection. False positives due to blood culture contamination (BCC) vary from 1% to as high as >10% of all BC results. False-positive BC results may result in patients undergoing unnecessary antimicrobial treatments, increased healthcare costs, and delay in detecting the true cause of infection or other non-infectious illness. Previous guidelines from the Clinical and Laboratory Standards Institute, College of American Pathologists, and others, based on expert opinion and surveys, promoted a limit of ≤3% as acceptable for BCC rates. However, the data supporting such recommendations are controversial. A previous systematic review of BCC examined three practices for reducing BCC rates (venipuncture, phlebotomy teams, and pre-packaged kits). Subsequently, numerous studies on different practices including using diversion devices, disinfectants, and education/training to lower BCC have been published. The goal of the current guideline is to identify beneficial intervention strategies to reduce BCC rates, including devices, practices, and education/training by providers in collaboration with the laboratory. We performed a systematic review of the literature between 2017 and 2022 using numerous databases. Of the 11,319 unique records identified, 311 articles were sought for full-text review, of which 177 were reviewed; 126 of the full-text articles were excluded based on pre-defined inclusion and exclusion criteria. Data were extracted from a total of 49 articles included in the final analysis. An evidenced-based committee's expert panel reviewed all the references as mentioned in Data Collection and determined if the articles met the inclusion criteria. Data from extractions were captured within an extraction template in the US Agency for Healthcare Research and Quality's Systematic Review Data Repository (https://srdr.ahrq.gov/). BCC rates were captured as the number of events (contaminated samples) per arm (standard practice versus improvement practice). Modified versions of the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for risk of bias assessment (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). We used Grading of Recommendations, Assessment, Development and Evaluations to assess strength of evidence. There are several interventions that resulted in significant reduction in BCC rates: chlorhexidine as a disinfectant for skin preparation, using a diversion device prior to drawing BCs, using sterile technique practices, using a phlebotomy team to obtain BCs, and education/training programs. While there were no substantial differences between methods of decreasing BCC, our results indicate that the method of implementation can determine the success or failure of the intervention. Our evidence-based systematic review and meta-analysis support several interventions to effectively reduce BCC by approximately 40%-60%. However, devices alone without an education/training component and buy-in from key stakeholders to implement various interventions would not be as effective in reducing BCC rates.

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BackgroundSurgical site infection (SSI) is the prevailing complication that occurs after surgery and significantly escalates healthcare expenses. Published meta-analyses and international standards vary in their recommendations for the most effective preoperative skin antiseptic solution and concentration.ObjectiveThe aim of this systematic review and meta-analysis is to assess the effectiveness of chlorhexidine-alcohol compared to aqueous/alcoholic iodine solutions in preventing postoperative surgical site infections.MethodsA systematic search was conducted using four electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals. The risk ratio (RR) was calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane Q and I2 statistics and the appropriate P value. The analysis used RevMan 5.4.ResultsThe current meta-analysis includes 14 randomized controlled trials (RCTs) comparing either 2-2.5% chlorhexidine-alcohol with aqueous/alcoholic iodine. It was demonstrated that the CAG-using group had an overall lower incidence of postoperative surgical site infections compared to the iodine-using group (RR=0.30, 95% CI=0.20-0.46, I2 =95%, P ConclusionThis meta-analysis suggests using either 2.0-2.5% chlorhexidine in alcohol instead of aqueous, alcoholic iodine to prevent SSIs in adult patients undergoing surgery. Chlorhexidine in alcohol worked effectively for general surgery, cesarean sections, and other surgeries. Thus, preoperative skin cleansing with chlorhexidine-alcohol minimizes postoperative SSIs and bacterial colonization in diverse procedures.

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Candida auris possesses distinctive features that facilitate its persistence and transmission in healthcare settings, causing outbreaks of infection that are difficult to treat. So, emphasis has been placed on implementing measures for controlling, eliminating, and preventing fungal transmission, such as environmental disinfection and patient decolonization. This review aimed to understand and analyze the agents for environmental disinfection and patient decolonization reported in the last 5 years. The PubMed database was reviewed, using the terms "Candida auris", "disinfection", and "decolonization". Only original papers, published between 2020-2025, in English or Spanish, that included relevant information on the topic, were selected. After the selection process, 52 articles were chosen to analyze the agents for environmental disinfection and decolonization of C. auris. Natural and synthetic disinfectants and ultraviolet radiation were reported for the environmental disinfection, with variable efficacy, depending on factors such as concentration and exposure time. Natural and synthetic antiseptics were also reported for decolonization, with varying efficacy. For example, 2% chlorhexidine shows a 0.5 log reduction, while at concentrations >10% it is >4 log. However, most have only been tested in animal models. Based on the review, Far-UV-C radiation (222 nm) is safe and appropriate to mitigate (up to 1 log reduction) the spread of C. auris in the hospital setting. However, it is important to consider that the cost and limited availability of the device present a barrier to its implementation. Patient decolonization is still challenging nowadays due to the absence of agents with proven high efficacy in humans.

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BackgroundChlorhexidine (CHX) and povidone-iodine (PVI) are the most commonly used antiseptic agents for preoperative skin preparation to prevent surgical site infections (SSIs). This meta-analysis aimed to determine the superior agent between them for SSI prevention.MethodsWe conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of electronic databases (PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials) was performed from inception to 1 May 2025, to identify relevant randomized controlled trials (RCTs). Heterogeneity was assessed using the chi-squared (Q) test and the I2 statistic. A random-effects model was applied when significant heterogeneity was present. The robustness of the findings was evaluated using trial sequential analysis (TSA) with a random-effects model. All statistical analyses were performed using Review Manager.ResultsA total of 32 high-quality RCTs, involving 29,748 participants, were included. The pooled analysis using a random-effects model demonstrated that CHX was significantly more effective than PVI in preventing SSIs (RR = 0.83, 95% CI 0.72-0.95, p = 0.009). Subgroup analysis by wound classification revealed that CHX was superior to PVI in clean-contaminated surgeries (11 RCTs; RR = 0.75, 95% CI 0.62-0.92, p = 0.004), but no significant difference was observed in clean surgeries (20 RCTs; RR = 0.90, 95% CI 0.67-1.20, p = 0.46). Further stratification by SSI type indicated that CHX significantly reduced the risk of superficial incisional SSIs (18 RCTs; RR = 0.82, 95% CI 0.69-0.98, p = 0.03), but not deep incisional SSIs (16 RCTs; RR = 0.95, 95% CI 0.76-1.18, p = 0.63) or organ-space SSIs (11 RCTs; RR = 1.13, 95% CI 0.89-1.42, p = 0.32). Additionally, CHX was associated with a significantly lower risk of bacterial decolonization (RR = 0.38, 95% CI 0.26-0.57, p p = 0.02) compared to PVI. The TSA confirmed the robustness of these findings, indicating that the cumulative evidence was sufficient and conclusive.ConclusionCHX-based antiseptics are more effective than PVI-based ones in preventing overall SSIs, particularly in clean-contaminated procedures. The superiority of CHX is primarily evident in reducing superficial incisional SSIs, with no significant advantage observed for deep incisional or organ-space SSIs.

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Surgical site infections (SSIs) remain a leading cause of postoperative morbidity. While both chlorhexidine-alcohol (CHG-A) and povidone-iodine (PVI) are standard preoperative skin antiseptics, their comparative efficacy, particularly in clean-contaminated surgeries, where the benefit of CHG-A's persistent activity is most theorized, remains a subject of ongoing clinical debate. This meta-analysis aimed to evaluate whether CHG-A is superior to PVI in preventing SSIs in adult patients undergoing elective surgery, with a specific focus on clean-contaminated procedures. The primary outcome was overall SSI incidence within 30 days; secondary outcomes included deep incisional SSI, superficial incisional SSI, and adverse skin reactions. We conducted a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Web of Science, EMBASE, and the Cochrane Library were searched from inception to January 31, 2026, without language restrictions. We included randomized controlled trials (RCTs) comparing CHG-A with PVI for preoperative skin preparation in adults undergoing elective surgery and reporting 30-day SSI rates using standardized definitions. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. A random-effects model (DerSimonian-Laird method) was used for the meta-analysis, with heterogeneity quantified using the I² statistic. A prespecified subgroup analysis was conducted for clean-contaminated surgeries, and a leave-one-out sensitivity analysis was performed. Nine RCTs (n = 8,000 patients) were included. For overall SSI, no significant difference was found between CHG-A and PVI (risk ratio (RR) = 0.84, 95% CI: 0.66-1.07; I² = 48%). In a prespecified subgroup of five studies on clean-contaminated surgeries, the RR was 0.77 (95% CI: 0.58-1.03). Deep incisional SSI rates were lower with CHG-A, although not statistically significant (RR = 0.75, 95% CI: 0.53-1.07). Heterogeneity stemmed from variability in surgery types and antiseptic formulations. Sensitivity analysis indicated robustness, with the most substantial effect change occurring upon omission of a large cardiac surgery trial. This meta-analysis did not find conclusive evidence that CHG-A is superior to PVI for preventing overall SSI across all surgery types. A nonsignificant trend favoring CHG-A was observed in clean-contaminated procedures and for deep SSIs, suggesting a context-dependent effect that warrants targeted investigation. Clinical choice may consider the specific surgical context, cost, and institutional protocols.

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BackgroundSurgical site infection (SSI) is a major concern in orthopaedic surgery procedures as they can have devastating consequences for patients and their outcomes. Many infection prevention measures are routinely taken in order to prevent infection during surgery, the main one being surgical skin preparation prior to any incision.AimTo investigate the efficacy of different perioperative surgical skin preparation products commonly used in orthopaedic surgery.MethodsSeven databases were searched from inception to January 25, 2025, using a combination of keywords and medical subject headings terms, specifically for studies comparing any two surgical skin preparation products used at any point prior to skin incision for orthopaedic procedures. Titles and abstracts were screened and full texts reviewed based on inclusion criteria. Data was extracted on study design, interventions, and outcomes from studies that met inclusion criteria. Meta-analysis was not completed due to heterogeneity.ResultsThirty-two studies met the inclusion criteria in this systematic review. In extremity fracture surgery, evidence was mixed on whether iodine or chlorhexidine-based solutions are more effective at preventing SSI. No significant difference was found between iodine and chlorhexidine-based solutions in total joint arthroplasty, spine surgery, foot and ankle surgery, or upper extremity surgery. No tested preparation method was superior in reducing positive Cutibacterium acnes culture rates in upper extremity (shoulder) surgery. Adding adjuncts to iodine and chlorhexidine methods, such as isopropyl alcohol, hydrogen peroxide, or benzoyl peroxide showed no significant changes to SSI or bacterial cultures.ConclusionCurrent literature shows no significant difference between chlorhexidine-based and iodine-based skin preparation solutions in orthopaedic extremity or spine surgery regarding SSI prevention or culture results. Likewise, adding other antiseptic agents provided no clear benefit. While skin antisepsis is important, many different factors contribute to SSI risk outside of the skin preparation solution.

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BackgroundSurgical site infections (SSIs) are significant postoperative complications in gynecologic and obstetric surgeries. Preoperative vaginal antisepsis is vital for prevention. This review compares the efficacy and safety of chlorhexidine gluconate (CHG) vs. povidone-iodine (PI) for vaginal antisepsis in preventing postoperative infections.Materials and methodsA systematic search of major databases was conducted through 8 Ja-nuary 2025. Randomized controlled trials (RCTs) comparing CHG and PI for vaginal antisepsis during urogynecologic procedures were included. Meta-analyses were performed using random-effects models to estimate risk ratios (RRs) with 95% confidence intervals (CIs). The GRADE approach assessed the certainty of evidence. The primary outcome was SSIs; secondary outcomes included febrile morbidity, hospital stay, antiseptic-related side effects, and wound complications.ResultsTwelve RCTs, including 4936 participants, were analyzed. The results showed that CHG significantly reduced compared to PI (RR: 1.71; 95% CI: 1.30-2.26; I 2 = 17%; high-certainty evidence). Subgroup analyses showed higher SSI risk with PI in upper/lower-middle-income countries (RR: 1.79; 95% CI: 1.17-2.74) and high-income countries (RR: 1.66; 95% CI: 1.08-2.56). PI was also associated with increased risks of superficial SSIs (RR: 1.57), deep SSIs (RR: 2.35), and readmissions (RR: 1.59).ConclusionCHG was superior to PI in preventing SSIs in gynecologic and obstetric surgeries. With high-quality evidence supporting its use, CHG is recommended for vaginal preparation. Future research should explore cost-effectiveness and long-term outcomes.

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BackgroundShoulder infections are an unfortunate and serious complication of surgery. The prevention strategy for infections is multimodal, with a strong reliance on surgical preparation solutions. There is great variability in the use of and effectiveness of surgical preparation solutions; this review aims to identify the most effective methods of shoulder surgical site preparation in the literature.MethodsA systematic review and meta-analysis was conducted by 2 independent reviewers in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) framework. Articles were screened by title, then abstract, and finally by full text by each clinician independently. A third orthopedic clinician adjudicated any disagreement on the application of the inclusion criteria. Studies included were human clinical studies utilizing skin preparation methods for the shoulder in a simulated or real primary surgery setting. English language databases from 1980 until the first of January 2025 were accessed. The terms searched included "shoulder," combined with each of the terms "skin," "wound," "antibiotic," "decolonization," "topical," "eradication," "preparation," and "sterilization." The results were pooled and then analyzed in subgroups according to the timing of skin preparation, the solution used, and the area of sampling.ResultsThe search found 13,154 articles, of which 31 studies were included in the final study and captured a total of 2,115 patients who were cultured for organisms. The lowest rates of culture positivity at the time of surgery were associated with the use of benzoyl peroxide (27.1% culture positive) and prior-to-day-of-surgery preparation solution administration (30.5% culture positive). Patients who received preparation solutions with alcohol numbered 1,551, of which 577 (37.2%) had positive cultures. Patients who received preparation solutions without alcohol numbered 564, with 140 (24.8%) culture positive, P P = .027, chi-square = 4.89.ConclusionThere is a wide range of available surgical preparation solutions to attempt to prevent day-of-surgery culture positivity. However, even the most robust regiments still have a substantially high culture positivity rate at the time of surgery. Further trials are warranted to unify protocols for the management of perioperative shoulder preparation.

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Key Points Question What concentration and formulation of chlorhexidine or povidone-iodine is associated with the lowest incidence of catheter-related infections (catheter-related bloodstream infections, catheter tip colonization, or local infections)? Findings In this network meta-analysis and systematic review including 11 985 catheters from 16 randomized trials, alcohol-based rather than aqueous-based formulations, isopropyl alcohol rather than ethanol, chlorhexidine-based rather than povidone-iodine formulations, and higher (1% or higher) rather than lower concentrations of chlorhexidine for skin preparation were associated with lower infection rates. Meaning These findings suggest that high concentration chlorhexidine in isopropyl alcohol should be recommended as the first-line skin antiseptic before intravascular catheter insertion.

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