Preoperative skin antiseptics for preventing surgical wound infections after cle

星梦78

Preoperative skin antiseptics for preventing surgical wound infections after clean surgery

Peggy Edwards1,*, Allyson Lipp2,
• Alexandra Holmes3
  

Editorial Group: Cochrane Wounds Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 23 JUL 2008

DOI: 10.1002/14651858.CD003949.pub2

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Database Title

The Cochrane Library

Abstract

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Background
Approximately 15% of elective surgery patients and 30% of patients receiving contaminated or dirty surgery are estimated to develop post-operative wound infections. The costs of surgical wound infection can be considerable in financial as well as social terms. Preoperative skin antisepsis is performed to reduce the risk of post-operative wound infections by removing soil and transient organisms from the skin. Antiseptics are thought to be both toxic to bacteria and aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however it is unclear whether preoperative skin antisepsis actually reduces post-operative wound infection and if so which antiseptic is most effective.
Objectives
To determine whether preoperative skin antisepsis prevents post-operative surgical wound infection.
Search methods
For the update of this review we searched the Cochrane Wounds Group Specialised Trials Register (July 2008); the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 3 2008; Ovid MEDLINE, 2005 to July Week 3 2008; Ovid EMBASE, 2005 to 2008 Week 29 and Ovid CINAHL, 2005 to July Week 3 2008.
Selection criteria
Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There was no restriction on the inclusion of reports based on language of publication, date or publication status.
Data collection and analysis
Data extraction and assessment of study quality were undertaken by three authors independently.
Main results
For this first update we identified one additional trial resulting in seven eligible RCTs evaluating preoperative antiseptics. There was some heterogeneity in the comparisons and the results were pooled for three comparisons; iodophor-in-alcohol film forming antiseptic compared with povidone iodine scrub and paint, drape compared with no drape and povidone scrub and paint compared with povidone paint. In one study, infection rates were significantly lower when skin was prepared using chlorhexidine compared with iodine. There was no evidence of a benefit in four trials associated with the use of iodophor impregnated drapes.
Authors' conclusions
There is insufficient research examining the effects of preoperative skin antiseptics to allow conclusions to be drawn regarding their effects on post-operative surgical wound infections. Further research is needed.
  Plain language summary

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• Abstract
• Plain language summary
  

Preoperative skin antiseptics for preventing surgical wound infections after clean surgery
There is insufficient evidence from randomised trials to support or refute the use of one antiseptic over another. There is no evidence to show that iodophor impregnated incise drapes reduce infections when compared to using no incise drape. Patients' skin at the operation site is routinely cleaned with antiseptic solutions before surgery. One study found that there were fewer surgical site infections when the skin was prepared using chlorhexidine in comparison with preparation using iodine.