Use of iodine-impregnated surgical drapes for prevention of surgical site infection: a systematic review and meta-analysis

Background: Iodine-impregnated surgical drapes aim to protect the wound from bacterial re-colonisation and therefore prevent surgical site infection (SSI). Studies have produced conflicting results regarding the efficacy of this intervention. Methods: Ovid EMBASE, Ovid MEDLINE, Scopus and PubMed were searched for randomised control trials (RCTs) and cohort studies in which iodine-impregnated drapes were used to reduce SSI. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool for RCTs and the ROBINS-I tool for cohort studies. RevMan was used for meta-analysis. Additional sub-group analysis was performed for incision type. Results: Two RCTs and seven cohort studies inclusive of 4119 patients were included. The RCTs demonstrate a risk ratio (RR) for SSI in the intervention group of 0.92 (p=0.70), whereas the RR in the cohort studies is 0.45 (p=0.01). The number needed to prevent SSI in the cohort studies is 19.5. There is also a statistically significant reduction in SSI in the intervention group for clean-contaminated incisions, with SSI occurring in 3.8% of surgeries with an iodophor drape and 9.2% of surgeries without (RR 0.45, p=0.02). Conclusion: Our review suggests that iodine-impregnated drapes are beneficial in reducing postoperative SSI, particularly in clean-contaminated surgeries; however, the grade of evidence is poor.