Preoperative bathing or showering with skin antiseptics to prevent surgical site infection

Webster, Joan & Osborne, Sonya (2005) Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews.

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Background Surgical site infections are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a lower incidence of surgical site infection. Objectives To review the evidence for preoperative bathing or showering with antiseptics for the prevention of hospital-acquired (nosocomial) surgical site infection. Search strategy We searched the Cochrane Wounds Group Specialised Register (21 July 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (January 1966 to September 2004), EMBASE (January 1985 to September 2004) and reference lists of articles. Selection criteria Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in patients undergoing surgery. Data collection & analysis Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Main results Six trials involving a total of 10,007 participants were included. Three of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub). Three trials involving 7691 participants compared this antiseptic with a placebo. Bathing with chlorhexidine compared to a placebo did not result in a statistically significant reduction in the surgical site wound infection rate; the relative risk (RR) was 0.91 (95% confidence interval (CI) 0.80 to 1.04). Three trials of 1443 participants compared bar soap with chlorhexidine. When results of the three trials were combined no differences were detected, the RR was 1.02 (95% CI 0.57 to 1.84). Two trials of 1042 patients compared bathing with chlorhexidine with no washing. No difference was found in the postoperative surgical site wound infection rate between patients who washed with chlorhexidine compared with patients who did not wash preoperatively, the RR was 0.36 (95% CI 0.17 to 0.79).

Reviewers' conclusions Washing preoperatively with chlorhexidine offers no benefit over placebo or bar soap in preventing surgical site wound infection.

Impact and interest:

30 citations in Scopus
36 citations in Web of Science®
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ID Code: 3803
Item Type: Journal Article
Refereed: Yes
Additional Information: The review, when published, supercedes the Protocol which is published as:
Webster J, Osborne S. Pre-operative bathing or showering with skin antiseptics to reduce surgical site infection. (Protocol) The Cochrane Database of Systematic Reviews 2004, Issue 4.
DOI: 10.1002/14651858.CD004985.pub3
ISSN: 1465-1858
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Clinical Nursing - Secondary (Acute Care) (111003)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2005 Cochrane Database of Systematic Reviews
Copyright Statement: Reproduced in accordance with the copyright policy of the publisher.
Deposited On: 04 Apr 2006 00:00
Last Modified: 29 Feb 2012 13:28

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