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Preoperative bathing or showering with skin antiseptics to prevent surgical site infectionWebster J, Osborne S
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SummaryPreoperative bathing or showering with skin antiseptics to prevent surgical site infection.Surgical site infection is a serious complication of surgery and may be associated with increased length of hospital stay for the patient and higher hospital costs. The use of an antiseptic solution for pre-operative bathing or showering is widely practiced in the belief that it will help to prevent surgical site infection. However, the review found seven trials that included over 10,000 patients that did not show clear evidence of benefit for the use of chlorhexidine solution over other wash products.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 19. 2006 AbstractBackgroundSurgical site infections (SSIs) are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a lower incidence of surgical site infection. ObjectivesTo review the evidence for preoperative bathing or showering with antiseptics for preventing hospital-acquired (nosocomial) surgical site infection. Search strategyFor this second update we searched the Cochrane Wounds Group Specialised Register (March 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2009), Ovid MEDLINE (January 1950 to February Week 4 2009), Ovid EMBASE (1980 to 2009 Week 09), EBSCO CINAHL (1982 to February Week 4 2009) and reference lists of articles. Selection criteriaRandomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in patients undergoing surgery. Data collection and analysisTwo review authors independently assessed studies for selection, quality and extracted data. Study authors were contacted for additional information. Main resultsOne additional trial was included in this second update. Seven trials involving a total of 10,157 participants were included. Four of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub/Riohex). Three trials involving 7791 participants compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with placebo did not result in a statistically significant reduction in SSIs; the relative risk of SSI (RR) was 0.91 (95% confidence interval (CI) 0.80 to 1.04). When only trials of high quality were included in this comparison, the RR of SSI was 0.95 (95%CI 0.82 to 1.10). Three trials of 1443 participants compared bar soap with chlorhexidine; when combined there was no difference in the risk of SSIs (RR 1.02, 95% CI 0.57 to 1.84). Three trials of 1192 patients compared bathing with chlorhexidine with no washing, one large study found a statistically significant difference in favour of bathing with chlorhexidine (RR 0.36, 95%CI 0.17 to 0.79). The smaller studies found no difference between patients who washed with chlorhexidine and those who did not wash preoperatively. Authors' conclusionsThis review provides no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated. |