Use of plastic adhesive drapes during surgery for preventing surgical site infection

Following surgery, up to 30% of wounds may become infected. This complication of surgery may cause distress for the patient and lead to higher treatment costs. Many interventions have been designed to reduce postoperative infections. One of these is the use of a drape which adheres to the skin, and through which the surgeon cuts. It is thought that adhesive drapes prevent germs (which may be on the skin) from entering the open wound. This updated review of over 4000 patients, in seven separate trials could find no evidence that adhesive drapes reduce surgical site infection rates, and some evidence that they may increase infection rates.

Authors' conclusions: 

There was no evidence from the seven trials that plastic adhesive drapes reduce surgical site infection rates, and some evidence that they increase infection rates. Further trials may be justified, using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection, based on different wound classifications.

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Background: 

Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach. A systematic review was required to guide clinical practice.

Objectives: 

To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity.

Search strategy: 

For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 4th March 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid MEDLINE (2012 to 3rd March 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 2012 to 3rd March 2015); Ovid EMBASE (2012 to 3rd March 2015); and EBSCO CINAHL (2012 to 4th March 2015).

Selection criteria: 

Randomised controlled trials comparing any plastic adhesive drape with no plastic adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes, in patients undergoing any type of surgery. Ring drapes were excluded.

Data collection and analysis: 

Two review authors independently selected and assessed studies for trial quality and both independently extracted data. We contacted study authors for additional information.

Main results: 

We identified no new studies for this fourth update. The review includes five studies involving 3082 participants comparing plastic adhesive drapes with no drapes and two studies involving 1113 participants comparing iodine-impregnated adhesive drapes with no drapes. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drapes (risk ratio (RR) 1.23, 95% confidence interval (CI) 1.02 to 1.48, P = 0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.06 to 1.66, P = 0.89). Length of hospital stay was similar in the adhesive drape and non-adhesive drape groups.

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