Preoperative skin antiseptics for preventing surgical wound infections after clean surgery

Edwards P, Lipp A, Holmes A

Published Online:

July 8, 2009

There is insufficient evidence from randomised trials to support or refute the use of one antiseptic over another. There is no evidence to show that iodophor impregnated incise drapes reduce infections when compared to using no incise drape. Patients' skin at the operation site is routinely cleaned with antiseptic solutions before surgery. One study found that there were fewer surgical site infections when the skin was prepared using chlorhexidine in comparison with preparation using iodine.

Abstract (click to read)

Background:

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.

Objectives:

To determine whether preoperative skin antisepsis prevents post-operative surgical wound infection.

Search strategy:

For the update of this review we searched the Cochrane Wounds Group Specialised Trials Register (July 2008); the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 3 2008; Ovid MEDLINE, 2005 to July Week 3 2008; Ovid EMBASE, 2005 to 2008 Week 29 and Ovid CINAHL, 2005 to July Week 3 2008.

Selection criteria:

Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There was no restriction on the inclusion of reports based on language of publication, date or publication status.

Data collection and analysis:

Data extraction and assessment of study quality were undertaken by three authors independently.

Main results:

For this first update we identified one additional trial resulting in seven eligible RCTs evaluating preoperative antiseptics. There was some heterogeneity in the comparisons and the results were pooled for three comparisons; iodophor-in-alcohol film forming antiseptic compared with povidone iodine scrub and paint, drape compared with no drape and povidone scrub and paint compared with povidone paint. 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.

Authors' conclusions:

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.

This record should be cited as:

Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003949. DOI: 10.1002/14651858.CD003949.pub2

Assessed as up to date:

July 24, 2008

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Primary Review Group:

Health topics:

Skin > Surgery > Skin preparation methods

Wounds > Surgical wounds > Skin preparation methods

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Preoperative skin antiseptics for preventing surgical wound infections after clean surgery

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