Effectiveness of Chlorhexidine Impregnated Gauze Versus Povidone Iodine Dressing in Post Trauma Wound Care
Phase: NA
Conditions: Wound Infection Post-Traumatic, Wound Healing
Sponsor: Pakistan Institute of Medical Sciences

Effectiveness of 
Chlorhexidine Impregnated 
Gauze versus Povidone 
Iodine Dressing in Post 
Trauma Wound Care 
 
 
NCT Trial No. Not yet assigned 
Document date: 03/03/2026 
 

Introduction 
Wound care in trauma is important to avoid infection and enhance healing especially 
in large wounds requiring skin grafts. Povidone-Iodine (PI) soaked dry gauze 
dressings are widely used for this purpose as it is cheap and easily available. It has 
a wide antimicrobial spectrum. It exerts activity against bacteria, viruses, fungi, and 
protozoa. But there are now concerns regarding its cytotoxicity toward granulation 
tissue and epithelial cells. Thus, it is hypothesized to have a negative role in wound 
healing [1-2]. This discovery makes Povidone-Iodine detrimental to wounds that 
require skin grafts as they require granulation tissue to survive. 
 
Chlorhexidine is another easily available antiseptic agent. It also has a broad 
antimicrobial spectrum against both gram positive and negative bacteria. 
Chlorhexidine is available both in liquid form for dry gauze dressings as well as in the 
form of chlorhexidine impregnated paraffin gauze (CHG) dressings. CHG are 
nowadays favoured, because they provide decreased cytotoxicity compared with PI 
dressings [3-4].  
 
Comparisons of povidone iodine and chlorhexidine as antiseptic liquids have shown 
mixed results. A meta-analysis concluded that dry chlorhexidine dressings are 
associated with a lower risk of wound infections [5, 6]. Another study reveals no 
significant decrease in infection rate with chlorhexidine [7]. So, some studies favour 
PI for its quick action, while others emphasise the prolonged action of chlorhexidine 
[8]. Chlorhexidine impregnated paraffin gauze also promotes faster healing by 
maintaining a moist environment and reduced cytotoxicity toward granulation tissue 
and epithelial cells [9]. 
 
Gray JG et. al reports an infection rate of 9.9% in wounds with dry povidone-iodine 
dressings [10]. Similarly, Wang HX et. al reported an infection rate of 1.3% in wounds 
applied with dry chlorhexidine dressing [11]. So a net reduction in infection rate is 
expected with use of chlorhexidine dressing however the use of chlorhexidine 
impregnated paraffin gauze has not been studied. 
 
Kaya AZ et. al reports a wound healing rate of 54% in wounds applied with 
povidone-iodine gauze [12]. Similarly, Arslan NC et. al reported a healing rate of 
94.2% in wounds irrigated with 0.05% Chlorhexidine [13]. So a stark improvement in 
wound healing rate was observed with the use of chlorhexidine. But there is no data 
on the use of chlorhexidine impregnated gauze for wound healing rate as well. The 
conventional paraffin gauze has been used but it has a higher infection rate than the 
newer chlorhexidine impregnated paraffin gauze available by the brand name 
Bactigras, Paratulle, etc [14]. 
 

This study aims to determine if chlorhexidine impregnated paraffin gauze dressings 
are superior to dry povidone-iodine dressings for decreasing infection and improving 
wound healing in post trauma large wounds requiring skin grafts. 
Objectives 
To compare rate of infection and wound healing between chlorhexidine impregnated 
paraffin gauze and dry povidone-iodine dressings in post-traumatic large wounds 
requiring skin grafts. 
Operational Definition 
Wound Infection: A wound will be considered infected if it reaches Grade IV (Pus 
present) or Grade V (Deep or severe infection with systemic upset) on the 
Southampton Wound Assessment Scale. 
 
Wound Healing: Clinical improvement of the wound bed and peri wound area, 
measured by a decrease in the cumulative GRADES Score below 8. 
Hypothesis 
Null Hypothesis (H0): There is no significant difference between 
Chlorhexidine-impregnated paraffin gauze and Povidone-Iodine dressings in terms of 
infection rate and wound healing in post trauma large wounds requiring skin grafts. 
 
Alternative Hypothesis (H1): Chlorhexidine-impregnated paraffin gauze leads to a 
lower infection rate and improved wound healing in post trauma large wounds 
requiring skin grafts. 
Methodology 
Study Design: This study will be a prospective, single blind randomised controlled 
trial (Unique Protocol ID: No.F.1-1/2015/ERB/SZABMU/1482). 
 
Setting: This study will be carried out in the out-patient clinics, emergency and 
surgical wards of the Burn and Plastic Surgery Department at Pakistan Institute of 
Medical Sciences. 
 
Duration of Study: 3 months after approval of synopsis. 
 
Sample Size: The incidence of infection within the Povidone Iodine group is 9.9 % 
[10]. The incidence of infection within the Chlorhexidine Impregnated Paraffin Gauze 
group is 1.3 % [11]. The total required sample size calculated using WHO Calculator 
for incidence of infection was 176 patients with 88 patients per group [15]. 

 
Sampling Technique: Simple Random Sampling. Patients will be allocated to either 
Group A (CHG) or Group B (PI) using a computer-generated random number table. 
 
Sample Selection 
Inclusion criteria: 
●​ Patients 18-65 years of age with acute post trauma large wounds requiring 
skin grafts. 
●​ Wounds that are clean contaminated at presentation. 
 
Exclusion criteria: 
●​ Patients with the known allergies to Chlorhexidine or Povidone-Iodine. 
●​ Chronic wounds or those with underlying chronic conditions, such as 
diabetes. 
●​ Patients with compromised immune systems. 
●​ Pregnant females 
Data Collection 
Ethical approval for the study will be obtained from the Ethical Review Board of 
SZABMU Islamabad. Patients with post trauma wounds requiring skin grafts will be 
first selected according to the inclusion and exclusion criteria. Informed consent will 
be obtained from all patients via a separate consent proforma. Patients will then be 
randomized into either the chlorhexidine impregnated paraffin gauze group (CHG) or 
dry povidone-iodine dressing group (PI) via computer-generated random number 
table. After initial assessment, removal of foreign bodies and debridement of wounds 
the dressing will be applied as per the group assigned to the patient. The dressing 
will then be covered using sterile gauze and an elasticated support bandage will be 
placed over it. 
 
The operating surgeon will then fill out the form on day 1 of injury. The patient's 
hospital number, patient’s group and assessment day will be noted. Patient 
demographic data such as age and gender will also be noted. The time between 
initial trauma and hospitalization, Southampton wound grade, Grades score for 
wound healing and post-op day when initial clinical suspicion of wound infection 
occurred will also be recorded.  
 
The patient will then be reassessed similarly on post-op day 7, 14 and 21. 
Southampton wound grade, Grades score for wound healing and post-op day when 
initial clinical suspicion of wound infection occurred will then be recorded for each 
patient. Data confidentiality will be strictly maintained.  

Data Analysis 
Statistical analysis will be performed using IBM SPSS Statistics (Version 26.0 or 
later). A p-value of < 0.05 will be considered the threshold for statistical significance, 
with a 95% Confidence Interval (CI) reported where applicable. 
 
Prior to the primary analysis, the data will be screened for outliers and missing 
values. The Shapiro-Wilk test and visual inspection of histograms will be used to 
assess the normality of distribution for continuous variables (e.g., Age, GRADES 
score). 
 
Patient gender, presence/absence of wound infection (Southampton Grade IV or V), 
and wound healing (Grades score below 8) will be summarized as frequencies (n) 
and percentages (%). Normally distributed data (e.g., Age, time since injury to 
hospitalization, GRADES score) will be presented as Mean ± Standard Deviation 
(SD), Median and Interquartile Range (IQR).  
 
To determine the infection and healing rate between the CHG and PI groups, the 
Pearson Chi-Square test will be employed. If any cell count is less than 5, Fisher’s 
Exact Test will be used instead.  
 
Effect modifiers like age, gender, etc will be stratified by using post stratified 
chi-square test. 
 

References 
1.​ Harun H, Haroen H, Mirwanti R, Apriani N, Akuoko C. Uncovering the benefits 
of povidone iodine compared to other therapeutic agents in wound infection 
prevention and healing outcomes: a scoping review. J Multidiscip Healthc. 
2024;17:3605-16. doi: 10.2147/JMDH.S469037 
2.​ Bai D, Zhou F, Wu L. Comparing the efficacy of chlorhexidine and 
povidone–iodine in preventing surgical site infections: a systematic review and 
meta-analysis. Int Wound J. 2023;21:e14463. doi: 10.1111/iwj.14463 
3.​ Unal E, Ersoz G, Demir AF, Kaya S, Arikan S. Comparison of povidone-iodine 
and chlorhexidine gluconate in the prevention of surgical site infections: a 
randomized controlled trial. J Hosp Infect. 2024;145:112-120. 
doi:10.1016/j.jhin.2023.12.015 
4.​ Zhu R, Zhao Y, Xiao L, Liao M, Wang Y, He Q. Effectiveness and safety of 
chlorhexidine-impregnated dressings in preventing catheter-related infections: 
a systematic review and meta-analysis of randomized controlled trials. Front 
Med. 2023;10:1145321. doi:10.3389/fmed.2023.1145321 
5.​ Wang P, Wang D, Zhang L. Effectiveness of chlorhexidine versus 
povidone-iodine for preventing surgical site wound infection: a meta-analysis. 
Int Wound J. 2023;21:e14394. doi: 10.1111/iwj.14394 
6.​ Bai D, Zhou F, Wu L. Comparing the efficacy of chlorhexidine and 
povidone–iodine in preventing surgical site infections: a systematic review and 
meta-analysis. Int Wound J. 2023;21:e14463. doi: 10.1111/iwj.14463 
7.​ Hanish SJ, Kirwan MJ, Hou N, Coble TJ, Mihalko WM, Holland CT. Surgical 
site preparation using alcohol with chlorhexidine compared with povidone 
iodine with chlorhexidine results in similar rate of infection after primary total 
joint arthroplasty. Antibiotics. 2025;14(2):155. doi: 
10.3390/antibiotics14020155 
8.​ Krishna BKV, Madhavi AS. Preoperative skin antisepsis with povidone-iodine 
versus chlorhexidine: a prospective comparative study on surgical site 
infection prevention. Eur J Cardiovasc Med. 2025;15(8):304-8 
9.​ Sadeghi M, Mohammadi N, Nourian M. Comparing the effect of 
chlorhexidine-impregnated dressing and silver-impregnated dressing on pain 
and healing of traumatic wounds: a randomized clinical trial. Trauma Mon. 
2023;28(4):815-824. doi:10.30491/TM.2023.385412 
10.​Gray JG, Lee MJ. The effect of topical povidone iodine on wound infection 
following abdominal surgery. Br J Surg. 1981 May;68(5):310-3. doi: 
10.1002/bjs.1800680506. PMID: 7013895 
11.​Wang HX, Xie SY, Wang H, Chu HK. The Effects of Chlorhexidine Dressing 
on Health Care-Associated Infection in Hospitalized Patients: A 
Meta-Analysis. Iran J Public Health. 2019 May;48(5):796-807. PMID: 
31523635; PMCID: PMC6717407. 

12.​Kaya AZ, Turani N, Akyüz M. The effectiveness of a hydrogel dressing 
compared with standard management of pressure ulcers. J Wound Care. 
2005 Jan;14(1):42-4. doi: 10.12968/jowc.2005.14.1.26726. 
13.​Arslan NC, Degirmenci A, Ozdenkaya Y, Terzi C. Wound Irrigation with 
Chlorhexidine Gluconate Reduces Surgical Site Infection in Pilonidal Disease: 
Single-Blind Prospective Study. Surg Infect (Larchmt). 2020 
Jun;21(5):441-446. doi: 10.1089/sur.2019.053. 
14.​Chintha R, Balakrishnan S, Selvaraj K. Comparison of collagen dressing 
versus conventional (paraffin/cotton gauze) for donor site dressing in split skin 
graft patients: a prospective observational study. Cureus. 2024 Sep 
11;16(9):e69195. doi: 10.7759/cureus.69195. 
15.​World Health Organization. Sample size calculator [Internet]. Geneva: World 
Health Organization; 2023 [cited 2026 Feb 17].
 

Effectiveness of Chlorhexidine Impregnated Gauze versus 
Povidone Iodine Dressing in Post Trauma Wound Care 
 
Day 1: 
 
Patient’s MR Number: ____________          
 
Patient’s Group: ___________ 
 
Assessment Day: ___________ 
 
Participant Age: ____________ 
 
Participant Gender (Tick the appropriate Gender):     M                  F 
 
Time between initial trauma and hospitalization (in terms of hours): ____________ 
 
Southampton Wound Grade: ____________ 
 
Grades score for wound healing: ____________ 
 
Clinical suspicion of wound infection (in terms of day 1-21, Mark NA for no  
infection): __________ 
 
Day 7: 
 
Southampton Wound Grade: ____________ 
 
Grades score for wound healing: ____________ 
 
Clinical suspicion of wound infection (in terms of day 1-21, Mark NA for no  
infection): __________ 
 
Day 14: 
 
Southampton Wound Grade: ____________ 
 
Grades score for wound healing: ____________ 
 
Clinical suspicion of wound infection (in terms of day 1-21, Mark NA for no  
infection): __________ 

 
Day 21: 
 
Southampton Wound Grade: ____________ 
 
Grades score for wound healing: ____________ 
 
Clinical suspicion of wound infection (in terms of day 1-21, Mark NA for no  
infection): __________