Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-28T02:08:37.420Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  02 January 2015

Chris Kamel*
Affiliation:
Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
Lynda McGahan
Affiliation:
Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
Julie Polisena
Affiliation:
Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
Monika Mierzwinski-Urban
Affiliation:
Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
John M. Embil
Affiliation:
Department of Medicine, Section of Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
*
600-865 Carling Avenue, Ottawa, Ontario K1S 5S8, Canada ([email protected])

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.

Type
Review Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20(11):725730.Google Scholar
2. Institute for Healthcare Improvement (IHI). OSF Surgical Safety Success Story. Cambridge, MA: IHI, 2011.Google Scholar
3. National Collaborating Centre for Women's and Children's Health. Surgical Site Infection: Prevention and Treatment of Surgical Site Infection. London: National Institute for Health and Clinical Excellence, 2008. http://www.nice.org.uk/nicemedia/live/11743/42378/42378.pdf. Accessed August 3, 2010.Google Scholar
4. Safer Healthcare Now! Prevent Surgical Site infections: Getting Started Kit. Ottawa: Canadian Patient Safety Institute, 2010. http://www.saferhealthcarenow.ca/EN/Interventions/SSI/Documents/SSI%20Getting%20Started%20Kit.pdf. Accessed April 20, 2011.Google Scholar
5. Edwards, P, Lipp, A, Holmes, A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev 2009;(1):CD003949.Google Scholar
6. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, WR, Jarvis; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20(4):250278.Google Scholar
7. Kamel, C, McGahan, L, Mierzwinski-Urban, M, Embil, J. Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections: A Systematic Review of the Clinical Evidence and Guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2011. http://www.cadth.ca/media/pdf/M0025_Pre-Operative_Skin_Prep_L3.pdf. Accessed July 27, 2011.Google Scholar
8. Downs, SH, Black, N. 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.Google Scholar
9. Liberati, A, Altman, DG, Tetzlaff, J, 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.Google Scholar
10. Zywiel, MG, Daley, JA, Delanois, RE, Naziri, Q, Johnson, AJ, Mont, MA. Advance pre-operative Chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty. Int Orthop 2011; 35(7):10011007.Google Scholar
11. Murray, MR, Saltzman, MD, Gryzlo, SM, Terry, MA, Woodward, CC, Nuber, GW. Efficacy of preoperative home use of 2% Chlorhexidine gluconate cloth before shoulder surgery. J Shoulder Elbow Surg 2011;20(6):928933.Google Scholar
12. Veiga, DF, Damasceno, CA, Veiga, FJ, et al. Influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures. Plast Reconstr Surg 2008;121(1): 115118.Google Scholar
13. Veiga, DF, Damasceno, CA, Veiga-Filho, J, et al. Randomized controlled trial of the effectiveness of Chlorhexidine showers before elective plastic surgical procedures. Infect Control Hosp Epidemiol 2009;30(1):7779.Google Scholar
14. Dizer, B, Hatipoglu, S, Kaymakcioglu, N, 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.Google Scholar
15. Johnson, AJ, Daley, JA, Zywiel, MG, Delanois, RE, Mont, MA. Preoperative Chlorhexidine preparation and the incidence of surgical site infections after hip arthroplasty. J Arthroplasty 2010; 25(suppl 6):98102.Google Scholar
16. Magera, JS, Inman, BA, Elliott, DS. 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.Google Scholar
17. Meier, DE, Nkor, SK, Aasa, D, OlaOlorun, DA, Tarpley, JL. Prospective randomized comparison of two preoperative skin preparation techniques in a developing world country. World J Surg 2001;25(4):441443.Google Scholar
18. Kalantar-Hormozi, AJ, Davami, B. No need for preoperative antiseptics in elective outpatient plastic surgical operations: a prospective study. Plast Reconstr Surg 2005;116(2):529531.Google Scholar
19. Paocharoen, V, Mingmalairak, C, Apisarnthanarak, A. Comparison of surgical wound infection after preoperative skin preparation with 4% Chlorhexidine [correction of chlohexidine] and povidone iodine: a prospective randomized trial. JMed Assoc Thai 2009;92(7):898902.Google Scholar
20. Kehinde, EO, Jamal, W, Ali, Y, Khodakhast, F, Sahsah, M, Rotimi, VO. Comparative efficacy of two methods of skin preparation of the perineal and genital skin of male urological patients. Kuwait Med J 2009;41(2):103107.Google Scholar
21. Veiga, DF, Damasceno, CA, Veiga-Filho, J, 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.Google Scholar
22. Darouiche, RO, Wall, MJ Jr, Itani, KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):1826.Google Scholar
23. Segal, CG, Anderson, JJ. Preoperative skin preparation of cardiac patients. AORN J 2002;76(5):821828.Google Scholar
24. Levin, I, Amer-Alshiek, J, Avni, A, Lessing, JB, Satei, A, Almog, B. Chlorhexidine and alcohol versus povidone-iodine for antisepsis in gynecological surgery. J Womens Health (Larchmt) 2011;20(3): 321324.Google Scholar
25. Swenson, BR, Hedrick, TL, Metzger, R, Bonatti, H, Pruett, TL, Sawyer, RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infect Control Hosp Epidemiol 2009; 30(10):964971.Google Scholar
26. Boston, KM, Baraniuk, S, O'Heron, S, Murray, KO. Risk factors for spinal surgical site infection, Houston, Texas. Infect Control Hosp Epidemiol 2009;30(9):884889.Google Scholar
27. Bucher, BT, Guth, RM, Elward, AM, et al. Risk factors and outcomes of surgical site infection in children. J Am Coll Surg 2011; 212(6):10331038.Google Scholar
28. Jacobson, C, Osmon, DR, Hanssen, A, et al. Prevention of wound contamination using DuraPrep solution plus Ioban 2 drapes. Clin Orthop Relat Res 2005;439:3237.Google Scholar
29. Yoshimura, Y, Kubo, S, Hirohashi, K, et al. Plastic iodophor drape during liver surgery operative use of the iodophor-impregnated adhesive drape to prevent wound infection during high risk surgery. World J Surg 2003;27(6):685688.Google Scholar
30. Webster, J, Osborne, S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2010;(1):CD004985.Google Scholar
31. Jakobsson, J, Perlkvist, A, Wann-Hansson, C. Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: a systematic review. Worldviews Evid Based Nurs 2011;8(3):143152.Google Scholar
32. Lee, I, Agarwal, RK, Lee, BY, Fishman, NO, Umscheid, CA. Systematic review and cost analysis comparing use of Chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol 2010;31 (12): 12191229.Google Scholar
33. Noorani, A, Rabey, N, Walsh, SR, Davies, RJ. Systematic review and meta-analysis of preoperative antisepsis with Chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg 2010;97(11):16141620.Google Scholar
34. Bibbo, C, Patel, DV, Gehrmann, RM, Lin, SS. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res 2005; 438:204208.Google Scholar
35. Ostrander, RV, Botte, MJ, Brage, ME. Efficacy of surgical preparation solutions in foot and ankle surgery. JBone Joint Surg Am 2005;87(5):980985.Google Scholar
36. Culligan, PJ, Kubik, K, Murphy, M, Blackwell, L, Snyder, J. A randomized trial that compared povidone iodine and Chlorhexidine as antiseptics for vaginal hysterectomy. Am J Obstet Gynecol 2005;192(2):422425.Google Scholar
37. Saltzman, MD, Nuber, GW, Gryzlo, SM, Marecek, GS, Koh, JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am 2009;91(8):19491953.Google Scholar