Preoperative skin antiseptics for preventing surgical wound infections after clean surgery (Review)

National Patient Safety Agency, 4-8 Maple Street, London, UK, W1T 5HD.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2004; (4)(3):CD003949. DOI: 10.1002/14651858.CD003949.pub2
Source: PubMed


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.
To determine whether preoperative skin antisepsis reduces post-operative surgical wound infection.
We searched the Cochrane Wounds Group Specialised Trials Register and the Cochrane Central Register of Controlled Trials in April 2004. In addition we handsearched journals, conference proceedings and bibliographies.
Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There were no restrictions based on language, date or publication status.
Three reviewers independently undertook data extraction and assessment of study quality. Pooling was inappropriate and trials are discussed in a narrative review.
We identified six eligible RCTs evaluating preoperative antiseptics. There was significant heterogeneity in the comparisons and the results could not be pooled. 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.
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.

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Available from: Allyson Lipp, Mar 17, 2014
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    • "The Centers for Disease Control and Prevention (CDC) estimates that 22% of all health-care-associated infections are SSIs, with an increasing percentage over the last decade [1,2]. SSIs increase morbidity as well as mortality, double the length of hospital stay [3-6] and increase the cost of surgery two- to five-fold [7]. "
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    ABSTRACT: Objective To investigate anti-infective treatments in HIV-infected surgical patients during the perioperative period. Methods A retrospective study of sepsis and surgical site infections (SSIs) was conducted in 266 HIV-infected patients. The patients were divided into 3 groups based on CD4+ T cells counts in the preoperative period: group A (0–199 cell/ul), group B (200–349 cell/ul) and group C ([greater than or equal to] 350 cell/ul). When the CD4 count was below 350 cells/uL, anti-retrovirus therapy was started. For patients whose preoperative CD4 counts were [less than or equal to] 200 cells/uL, preoperative antibiotic medication was started. Results Patients in group A were more likely to get sepsis than patients in the other two groups (p0.01). Among 82 patients with clean wounds, only one patient got SSIs. All patients with dirty wounds had acquired SSIs after surgery. There were only 6 patients dead at 30 days after surgery, a death rate of 2.3%. Sepsis appeared in 110 patients (41%). Conclusions Complete evaluation of surgical risk and suitable perioperative anti-infective treatment may lead to better outcome for HIV-infected surgical patients.
    AIDS Research and Therapy 11/2012; 9(1):36. DOI:10.1186/1742-6405-9-36 · 1.46 Impact Factor
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    • "The Centers for Disease and Prevention (CDC) estimates that 22% of all the health-care-associated infections are SSI, with an increasing percentage over the last decennium [1,2]. SSI increase morbidity as well as mortality, double the length of hospital stay [3-6] and increase the cost of surgery two-fivefold [7]. Kirkland et al. showed that 60% of the patients who develop an SSI are more likely to be admitted to an intensive care unit (ICU), or to be hospitalized for another 5 days and more than five times more likely to be re-admitted. "
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    ABSTRACT: Surgical site infection (SSI) are the third most frequently reported nosocomial infection, and the most common on surgical wards. HIV-infected patients may increase the possibility of developing SSI after surgery. There are few reported date on incidence and the preventive measures of SSI in HIV-infected patients. This study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients. And we also explored the preventive measures. A retrospective study of SSI was conducted in 242 HIV-infected patients including 17 patients who combined with hemophilia from October 2008 to September 2011 in Shanghai Public Health Clinical Center. SSI were classified according to Centers for Disease Control and Prevention (CDC) criteria and identified by bedside surveillance and post-discharge follow-up. Data were analyzed using SPSS 16.0 statistical software (SPSS Inc., Chicago, IL). The SSI incidence rate was 47.5% (115 of 242); 38.4% incisional SSIs, 5.4% deep incisional SSIs and 3.7% organ/space SSIs. The SSI incidence rate was 37.9% in HIV-infected patients undergoing abdominal operation. Patients undergoing abdominal surgery with lower preoperative CD4 counts were more likely to develop SSIs. The incidence increased from 2.6% in clean wounds to 100% in dirty wounds. In the HIV-infected patients combined with hemophilia, the mean preoperative albumin and postoperative hemoglobin were found significantly lower than those in no-SSIs group (P<0.05). SSI is frequent in HIV-infected patients. And suitable perioperative management may decrease the SSIs incidence rate of HIV-infected patients.
    BMC Infectious Diseases 05/2012; 12(1):115. DOI:10.1186/1471-2334-12-115 · 2.61 Impact Factor
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    • "Arrival on the day of operation is becoming a routine. Antiseptic agents do not appear to differ much regarding postoperative infection rates (Edwards et al. 2009 "
    Acta Orthopaedica 12/2010; 81(6):660-6. DOI:10.3109/17453674.2010.537805 · 2.77 Impact Factor
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