Use of Plastic Adhesive Drapes During Surgery for Preventing Surgical Site Infection

Background Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach but no systematic review has been conducted to date to guide clinical practice. Objectives To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity. Search strategy We searched the Cochrane Wounds Group Specialised Register (last searched 24/4/07), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2,2007), Ovid MEDLINE (1950 to April Week 2, 2007), Ovid EMBASE (1980 to 2007 Week 16), and Ovid CINAHL (1982 to 1980 to April Week 2 2007). Selection criteria Randomised controlled trials comparing any plastic adhesive drape with no adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes in patients undergoing any type of surgery. Data collection & analysis Two authors independently selected and assessed studies for trial quality and both independently extracted data. Study authors were contacted for additional information. Main results This review includes five studies involving 3,082 participants comparing adhesive drapes with no drape and two studies involving 1,113 participants comparing iodine-impregnated adhesive drapes with no drape. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drape. (Relative Risk (RR) 1.23, 95% Confidence Intervals (CI) 1.02 to 1.48, p=0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.064 to 1.66, p=0.89). Length of hospital stay was similar in adhesive drape and non-adhesive drape groups. Reviewers' conclusions There was no evidence from the seven trials that plastic adhesive drapes reduces surgical site infection rate and some evidence that they increase infection rates. Further trials may be justified using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection based on different wound classifications.