O que usar no preparo cirúrgico da pele: povidona-iodo ou clorexidina?

Adriana Cristina de Oliveira; Camila Sarmento Gama

doi:10.5327/Z1414-4425201800030007

Autores

Adriana Cristina de Oliveira Universidade Federal de Minas Gerais
Camila Sarmento Gama Universidade Federal de Minas Gerais

DOI:

https://doi.org/10.5327/Z1414-4425201800030007

Palavras-chave:

Anti-infecciosos locais, Antissepsia, Clorexidina, Povidona-Iodo, Etanol.

Resumo

Objetivo: Discorrer sobre a eficácia do gluconato de clorexidina e do povidona-iodo em soluções aquosas ou alcoólicas na redução de infecções
do sítio cirúrgico e na contagem bacteriana da pele, no preparo pré-operatório do paciente. Método: Estudo de reflexão acerca do melhor antisséptico a
ser usado no preparo cirúrgico da pele. Resultados: Verificou-se que tanto a clorexidina quanto o povidona-iodo são igualmente seguros e efetivos e que
os manuais de boas práticas internacionais têm recomendado a sua utilização em soluções alcoólicas. Observou-se uma tendência na indicação da clorexidina
alcoólica e a emergência de estudos que têm avaliado o uso sequencial ou concomitante da clorexidina e do povidona-iodo com resultados favoráveis
a essa prática. Conclusão: Há uma tendência mundial mais favorável ao uso da clorexidina alcoólica em detrimento ao povidona-iodo. Contudo,
a decisão pelo melhor agente antisséptico deve considerar cada caso clínico, (contra) indicações e situação.

Referências

REFERÊNCIAS

A nderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger

EP, Greene L, et al. Strategies to prevent surgical site infections in

acute care hospitals: 2014 update. Infect Control Hosp Epidemiol.

;35(6):605-27. https://dx.doi.org/10.1086%2F676022

World Health Organization. Global guidelines for the prevention of

surgical site infection. Genebra: World Health Organization; 2016. 186p.

World Health Organization. WHO guidelines on hand hygiene in health

care. Genebra: World Health Organization; 2009. 270p.

Food and Drug Administration. Tentative final monograph for

healthcare antiseptic drug products; proposed rule. Federal Register.

;59:31441-52.

Hemani ML, Lepor H. Skin preparation for the prevention of surgical

site infection: which agent is best? Rev Urol. 2009;11(4):190-5.

Srinivas A, Kaman L, Raj P, Gautam V, Dahiya D, Singh G, et al.

Comparison of the efficacy of chlorhexidine gluconate versus povidone

iodine as preoperative skin preparation for the prevention of surgical

site infections in clean-contaminated upper abdominal surgeries. Surg

Today. 2015;45(11):1378-84. https://doi.org/10.1007/s00595-014-1078-y

U niversidade Federal do Triângulo Mineiro. Comissão de Controle de

Infecção Hospitalar. Manual de antissépticos padronizados do HC/

UFTM [Internet]. 2013 [citado em 11 mar. 2018]. Disponível em: http://

www.ebserh.gov.br/documents/147715/148046/ ANTISSEPTICOS_

PADRONIZADOS.pdf/5aee0778-a1c3-4f69-a75e-81b0159bb4c9

Darouiche RO, Wall MJJ, Itani KM, Otterson MF, Webb AL , Carrick MM,

et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site

antisepsis. N Engl J Med. 2010;362(1):18-26. https://doi.org/10.1056/

NEJMoa0810988

Rodrigues AL , Simões MLPB. Incidence of surgical site infection

with pre-operative skin preparation using 10% polyvidone-iodine

and 0,5% chlorhexidine-alcohol. Rev Col Bras Cir. 2013;40(6):443-8.

Springel EH, Wang X-Y, Sarfoh VM, Stetzer BP, Weight SA, Mercer

BM, et al. A randomized open-label controlled trial of chlorhexidinealcohol

vs povidone-iodine for cesarean antisepsis: the CAPICA trial.

Am J Obstet Gynecol. 2017;217(4):463.e1-8. https://doi.org/10.1016/j.

ajog.2017.05.060

Charehbili A, Swijnenburg RJ, Van de Velde C, Van den Bremer J,

Van Gijn W. A retrospective analysis of surgical site infections after

chlorhexidine–alcohol versus iodine–alcohol for pre-operative

antisepsis. Surg Infect. 2014;15(3):310-3. https://doi.org/10.1089/

sur.2012.185

Patrick S, McDowell A, Lee A, Frau A, Martin U, Gardner E, et al.

Antisepsis of the skin before spinal surgery with povidone iodinealcohol

followed by chlorhexidine gluconate-alcohol versus povidone

iodine-alcohol applied twice for the prevention of contamination of

the wound by bacteria. Bone Joint J. 2017;99-B(10):1354-65. https://

doi.org/10.1302/0301-620X.99B10.BJJ-2017-0291.R1

E dmiston CE, Bruden B, Rucinski MC, Henen C, Graham MB, L ewis

BL. Reducing the risk of surgical site infections: does chlorhexidine

gluconate provide a risk reduction benefit? Am J Infect Control.

;41(5 Supl.):S49-55. https://doi.org/10.1016/j.ajic.2012.10.030

Swenson BR, Hedrick TL, Metzger R, Bonatti H, Pruett TL, Sawyer

RG. Effects of preoperative skin preparation on postoperative wound

infection rates: a prospective study of 3 skin preparation protocols.

Infect Control Hosp Epidemiol. 2009;30(10):964-71. https://doi.

org/10.1086/605926

Mainwald M, Widmer AF, Rotter ML. Lack of evidence for attributing

chlorexidine as the main active ingredient in skin antiseptics preventing

surgical site infections. Infect Control Hosp Epidemiol. 2011;32(4):404-

https://doi.org/10.1086/659253

Bibi S, Shah SA, Qureshi S, Siddiqui TR, Soomro IA, A hmed W, et

al. Is chlorhexidine-gluconate superior than Povidone-Iodine in

preventing surgical site infections? A multicenter study. J Pak Med

Assoc. 2015;65(11):1197-201.

U ppal S, Bazzi A, Reynolds RK, Harris J, Pearlman MD, Campbell

DA, et al. Chlorhexidinealcohol

compared with povidoneiodine

for preoperative topical antisepsis for abdominal hysterectomy.

Obstet Gynecol. 2017;130(2):319-27. https://doi.org/10.1097/

AOG.0000000000002130

Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic

review and cost analysis comparing use of chlorhexidine with use

of iodine for preoperative skin antisepsis to prevent surgical site

infection. Infect Control Hosp Epidemiol. 2010;31(12):1219-29.

https://doi.org/10.1086/657134

E dwards PS, Lipp A, Holmes A. Preoperative skin antiseptics

for preventing surgical wound infections after clean surgery.

Cochrane Database Syst Rev. 2004;(3):CD003949. https://doi.

org/10.1002/14651858.CD003949.pub2

National Institute for Health and Clinical Excellence. Surgical site

infection: evidence update June 2013. Evidence update 43. 2013. 28p.

Cowperthwaite L, Holm RL. Guideline implementation: preoperative

patient skin antisepsis. AORN J. 2015;101(1):71-7. https://doi.

org/10.1016/j.aorn.2014.11.009

A nderson MJ, Horn ME, Lin YC, Parks PJ, Peterson ML. Efficacy

of concurrent application of chlorhexidine gluconate and povidone

iodine against six nosocomial pathogens. Am J Infect Control.

;38(10):826-31. https://doi.org/10.1016/j.ajic.2010.06.022

L anggartner J, Linde HJ, Lehn N, Reng M, Schölmerich J, Glück

T. Combined skin disinfection with chlorhexidine/propanol and

aqueous povidone-iodine reduces bacterial colonisation of central

venous catheters. Intensive Care Med. 2004;30(6):1081-8. https://

doi.org/10.1007/s00134-004-2282-9

Guzel A, Ozekinci T, Ozkan U, Celik Y, Ceviz A, Belen D. Evaluation of

the skin flora after chlorhexidine and povidone-iodine preparation in

neurosurgical practice. Surg Neurol. 2009;71(2):207-10. https://doi.

org/10.1016/j.surneu.2007.10.026

Davies BM, Patel HC. Does chlorhexidine and povidone-iodine

preoperative antisepsis reduce surgical site infection in cranial

neurosurgery? Ann R Coll Surg Engl. 2016;98(6):405-8. https://doi.

org/10.1308/rcsann.2016.0143

Davies BM, Patel HC. Systematic review and meta-analysis of

preoperative antisepsis with combination chlorhexidine and povidoneiodine.

Surg J. 2016;2(3):e70-7. https://doi.org/10.1055/s-0036-1587691

O que usar no preparo cirúrgico da pele: povidona-iodo ou clorexidina?

Autores

DOI:

Palavras-chave:

Resumo

Referências

Downloads

Publicado

Como Citar

Edição

Seção

Licença

Enviar Submissão

Informações