Effectiveness of surgical skin preparation solutions in orthopaedic surgery: A systematic review of the current comparative literature

Table 1 Surgical skin preparation demographics and results of studies evaluating more than one anatomical area

Ref.	Level of evidence	Surgery type	Sample size (n)	Interventions	Comparisons	Key findings
Beber et al[24], 2022, United States	Retrospective cohort (level 3)	Pediatric sports/UE, pediatric trauma, pediatric hip and LE	1416	2% chlorhexidine gluconate in 70% isopropyl alcohol (U); povidone-iodine (U, concentration unspecified)	SSI between the two cohorts	No difference in SSI was noted for all procedures between the two cohorts; no difference in SSI was noted for spine or hip/LE procedures between the two cohorts; in sports/UE procedures, povidone-iodine had a significantly lower rate of SSI (P = 0.005)
Sprague et al[25], 2024, United States	Randomized crossover trial (level 1)	Open upper and lower extremity fractures	1638	Aqueous 4% chlorhexidine gluconate (P); aqueous 10% povidone-iodine (P)	Comparing SSI between the preparation cohorts	No statistical difference in SSI between the two preparation cohorts
Sprague et al[25], 2024, United States	Randomized control trial (level 1)	Closed pelvis/acetabulum and lower extremity fractures, open upper and lower extremity fractures	8485	2% chlorhexidine gluconate in 70% isopropyl alcohol (S); 0.7% iodine povacrylex in 74% isopropyl alcohol (S)	Comparing SSI between the preparation cohorts	Closed fractures using iodine povacrylex resulted in lower odds of an SSI when compared with the chlorhexidine group (P = 0.049); in open fractures, there was no difference in SSI between the two preparation cohorts

UE: Upper extremity; LE: Lower extremity; S: Stick application; P: Paint application; U: Unspecified application method; SSI: Surgical site infection.