预防性洗必泰洗浴还不能确定是否能降低SSI

蓝鱼o_0

Cochrane Database Syst Rev. 2012 Sep 12;9:CD004985. doi: 10.1002/14651858.CD004985.pub4.
Preoperative bathing or showering with skin antiseptics to prevent surgical site infection.Webster J, Osborne S.
SourceCentre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Brisbane, Australia. joan_webster@health.qld.gov.au.

AbstractBACKGROUND: Surgical 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.
OBJECTIVES: To review the evidence for preoperative bathing or showering with antiseptics for preventing hospital-acquired (nosocomial) surgical site infections.
SEARCH METHODS: For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 29 June 2012); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012 Issue 6); Ovid MEDLINE (2010 to June Week 3 2012), Ovid MEDLINE (In-Process & Other Non-Indexed Citations June 27, 2012); Ovid EMBASE (2010 to 2012 Week 25), EBSCO CINAHL (1882 to 21 June 2012) and reference lists of articles.
SELECTION CRITERIA: Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in people undergoing surgery.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for selection, risk of bias and extracted data. Study authors were contacted for additional information.
MAIN RESULTS: We did not identify any new trials for inclusion in this fourth 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' CONCLUSIONS: This 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.

Update of

hjs590822

什么东东？我们是中国人！！

阡陌

看不懂，但是预防性洗必泰沐浴还不能确定是否降低SSI，那沐浴这个环节是否可以不需要？

蓝鱼o_0

阡陌 发表于 2012-12-17 11:56

                               
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看不懂，但是预防性洗必泰沐浴还不能确定是否降低SSI，那沐浴这个环节是否可以不需要？

在指南里面，他是作为补充预防措施。不是核心预防措施。当所有的措施不能降低感染时候，可以考虑采用。

蓝鱼o_0

Am J Infect Control. 2012 Jun 19. [Epub ahead of print]
Preoperative chlorhexidine shower or bath for prevention of surgical site infection: A meta-analysis.
Chlebicki MP, Safdar N, O'Horo JC, Maki DG.
SourceDepartment of Infectious Diseases, Singapore General Hospital, Singapore.

Abstract
BACKGROUND: Chlorhexidine showering is frequently recommended as an important preoperative measure to prevent surgical site infection (SSI). However, the efficacy of this approach is uncertain.

METHODS: A search of electronic databases was undertaken to identify prospective controlled trials evaluating whole-body preoperative bathing with chlorhexidine versus placebo or no bath for prevention of SSI. Summary risk ratios were calculated using a DerSimonian-Laird random effects model and a Mantel-Haenzel dichotomous effects model.

RESULTS: Sixteen trials met inclusion criteria with a total of 17,932 patients: 7,952 patients received a chlorhexidine bath, and 9,980 patients were allocated to various comparator groups. Overall, 6.8% of patients developed SSI in the chlorhexidine group compared with 7.2% of patients in the comparator groups. Chlorhexidine bathing did not significantly reduce overall incidence of SSI when compared with soap, placebo, or no shower or bath (relative risk, 0.90; 95% confidence interval: 0.77-1.05, P = .19).

CONCLUSIONS: Meta-analysis of available clinical trials suggests no appreciable benefit of preoperative whole-body chlorhexidine bathing for prevention of SSI. However, most studies omitted details of chlorhexidine application. Better designed trials with a specified duration and frequency of exposure to chlorhexidine are needed to determine whether preoperative whole-body chlorhexidine bathing reduces SSI.

樵夫

近年来使用洗必泰洗浴来预防SSI是感控中的热点话题，这些meta分析提供给我们一些新的思路

江南水韵

看不懂！谁能够翻译！

西安猫

这两位作者一直都对术前沐浴防SSI的有效性有疑问。

石磊--wxmsl

西安猫 发表于 2012-12-20 02:16

                               
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这两位作者一直都对术前沐浴防SSI的有效性有疑问。

我也觉得有疑问，浓度在整个洗浴过程中如何保证？

云诺

以前看过一篇文章就支持术前沐浴