Efficacy of Chlorhexidine versus Povidone-Iodine for Skin Antisepsis in Foot and Ankle Surgery

Background Surgical site infection (SSI) poses a significant risk in foot and ankle surgery. While chlorhexidine (CHX) and povidone-iodine (PVP-I) are both used for preoperative skin preparation, their comparative efficacy remains unclear. This study aimed to compare the efficacy of CHX and PVP-I for skin antisepsis in foot and ankle surgery, and secondarily to evaluate the effect of adjunct forefoot scrubbing. Methods 200 patients undergoing foot and ankle surgery were assigned to one of four groups based on antiseptic agent (CHX or PVP-I) and skin prepare technique (with or without forefoot scrubbing). Bacterial cultures were obtained from the hallux nail fold and toe web space after draping and after surgery. Incidence of SSI within 12 months after surgery was recorded as the secondary outcome. Results CHX significantly reduced bacterial colonization at both sites after draping and after surgery compared to PVP-I (p < 0.05). Forefoot scrubbing further reduced bacterial growth at the hallux nail fold after surgery (p = 0.002). However, no significant difference in SSI incidence was observed between CHX (8%) and PVP-I (10%) groups, nor between scrubbing and non-scrubbing groups. Conclusion CHX demonstrated superior efficacy in reducing bacterial colonization compared to PVP-I. Adjunctive scrubbing provided additional reduction at the hallux nail fold after surgery. Level of evidence Level II, prospective cohort study