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Preoperative Skin Antiseptic Preparations for Preventing Surgical Site Infections: A Systematic Review

  • Chris Kamel (a1), Lynda McGahan (a1), Julie Polisena (a1), Monika Mierzwinski-Urban (a1) and John M. Embil (a2)...
Abstract
Objective.

To evaluate the clinical effectiveness of preoperative skin antiseptic preparations and application techniques for the prevention of surgical site infections (SSIs).

Design.

Systematic review of the literature using Medline, EMBASE, and other databases, for the period January 2001 to June 2011.

Methods.

Comparative studies (including randomized and nonrandomized trials) of preoperative skin antisepsis preparations and application techniques were included. Two researchers reviewed each study and extracted data using standardized tables developed before the study. Studies were reviewed for their methodological quality and clinical findings.

Results.

Twenty studies (n = 9,520 patients) were included in the review. The results indicated that presurgical antiseptic showering is effective for reducing skin flora and may reduce SSI rates. Given the heterogeneity of the studies and the results, conclusions about which antiseptic is more effective at reducing SSIs cannot be drawn.

Conclusions.

The evidence suggests that preoperative antiseptic showers reduce bacterial colonization and may be effective at preventing SSIs. The antiseptic application method is inconsequential, and data are lacking to suggest which antiseptic solution is the most effective. Disinfectant products are often mixed with alcohol or water, which makes it difficult to form overall conclusions regarding an active ingredient. Large, well-conducted randomized controlled trials with consistent protocols comparing agents in the same bases are needed to provide unequivocal evidence on the effectiveness of one antiseptic preparation over another for the prevention of SSIs.

Copyright
Corresponding author
600-865 Carling Avenue, Ottawa, Ontario K1S 5S8, Canada (chrisk@cadth.ca)
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8.SH Downs , N Black . The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52(6):377384.

9.A Liberati , DG Altman , J Tetzlaff , et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62(10):e1e34.

10.MG Zywiel , JA Daley , RE Delanois , Q Naziri , AJ Johnson , MA Mont . Advance pre-operative Chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty. Int Orthop 2011; 35(7):10011007.

11.MR Murray , MD Saltzman , SM Gryzlo , MA Terry , CC Woodward , GW Nuber . Efficacy of preoperative home use of 2% Chlorhexidine gluconate cloth before shoulder surgery. J Shoulder Elbow Surg 2011;20(6):928933.

12.DF Veiga , CA Damasceno , FJ Veiga , et al.Influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures. Plast Reconstr Surg 2008;121(1): 115118.

14.B Dizer , S Hatipoglu , N Kaymakcioglu , et al.The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery. J Clin Nurs 2009; 18(23):33253332.

15.AJ Johnson , JA Daley , MG Zywiel , RE Delanois , MA Mont . Preoperative Chlorhexidine preparation and the incidence of surgical site infections after hip arthroplasty. J Arthroplasty 2010; 25(suppl 6):98102.

16.JS Magera , BA Inman , DS Elliott . Does preoperative topical antimicrobial scrub reduce positive surgical site culture rates in men undergoing artificial urinary sphincter placement? J Urol 2007;178(4 pt 1):13281332.

17.DE Meier , SK Nkor , D Aasa , DA OlaOlorun , JL Tarpley . Prospective randomized comparison of two preoperative skin preparation techniques in a developing world country. World J Surg 2001;25(4):441443.

18.AJ Kalantar-Hormozi , B Davami . No need for preoperative antiseptics in elective outpatient plastic surgical operations: a prospective study. Plast Reconstr Surg 2005;116(2):529531.

21.DF Veiga , CA Damasceno , J Veiga-Filho , et al.Povidone iodine versus Chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. Plast Reconstr Surg 2008;122(5):170e171e.

22.RO Darouiche , MJ Wall Jr, KM Itani , et al.Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):1826.

23.CG Segal , JJ Anderson . Preoperative skin preparation of cardiac patients. AORN J 2002;76(5):821828.

24.I Levin , J Amer-Alshiek , A Avni , JB Lessing , A Satei , B Almog . Chlorhexidine and alcohol versus povidone-iodine for antisepsis in gynecological surgery. J Womens Health (Larchmt) 2011;20(3): 321324.

27.BT Bucher , RM Guth , AM Elward , et al.Risk factors and outcomes of surgical site infection in children. J Am Coll Surg 2011; 212(6):10331038.

28.C Jacobson , DR Osmon , A Hanssen , et al.Prevention of wound contamination using DuraPrep solution plus Ioban 2 drapes. Clin Orthop Relat Res 2005;439:3237.

31.J Jakobsson , A Perlkvist , C Wann-Hansson . Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: a systematic review. Worldviews Evid Based Nurs 2011;8(3):143152.

33.A Noorani , N Rabey , SR Walsh , RJ Davies . Systematic review and meta-analysis of preoperative antisepsis with Chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg 2010;97(11):16141620.

35.RV Ostrander , MJ Botte , ME Brage . Efficacy of surgical preparation solutions in foot and ankle surgery. JBone Joint Surg Am 2005;87(5):980985.

36.PJ Culligan , K Kubik , M Murphy , L Blackwell , J Snyder . A randomized trial that compared povidone iodine and Chlorhexidine as antiseptics for vaginal hysterectomy. Am J Obstet Gynecol 2005;192(2):422425.

37.MD Saltzman , GW Nuber , SM Gryzlo , GS Marecek , JL Koh . Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am 2009;91(8):19491953.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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