Preoperative Skin Preparation Prevents Surgical Site Infections

A new review of studies suggests that preoperative antiseptic showers reduce bacterial colonization and may be effective at preventing surgical site infections (SSIs).

Researchers at the Canadian Agency for Drugs and Technologies in Health (CADTH; Ottawa, Canada), and the University of Manitoba (Winnipeg, Canada) conducted a systematic review of literature using Medline, EMBASE, and other databases, for the period between January 2001 to June 2011, in order to evaluate the clinical effectiveness of preoperative skin antiseptic preparations and application techniques for the prevention of SSIs. Two researchers assessed each of the 20 studies included in the review and extracted data using standardized tables developed before the study.

The results of the reviews, which included data on 9,520 patients, indicated that presurgical antiseptic showering is effective for reducing skin flora, and may reduce SSI rates; the antiseptic application method, on the other hand, was found to be inconsequential. However, the researchers stressed that due to the heterogeneity of the studies and the results, conclusions about which antiseptic is more effective at reducing SSIs could not be drawn. The review was published on June 29, 2012, in Infection Control and Hospital Epidemiology.

“Disinfectant products are often mixed with alcohol or water, which makes it difficult to form overall conclusions regarding an active ingredient,” concluded lead author Chris Kamel, MSc, of the CADTH, and colleagues. “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.”

SSIs occur in approximately 2%-5% of patients who undergo clean extra-abdominal surgeries, such as thoracic and orthopedic surgery, and in up to 20% of patients who undergo intra-abdominal surgery interventions. Topical agents applied to the skin preoperatively to reduce SSI risk include iodophor (such as povidone-iodine), alcohol, and chlorhexidine gluconate (CHG). CHG and PI can be mixed with either alcohol or water, which may have implications for effectiveness.

Related Links:
Canadian Agency for Drugs and Technologies in Health
University of Manitoba