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

 

Abstract

Background

Surgical site infections (SSIs) 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 preventing hospital-acquired (nosocomial) surgical site infections.

Search methods

For this third update we searched the Cochrane Wounds Group Specialised Register (searched 5 November 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2010), Ovid MEDLINE (January 2008 to November Week 2 2010), Ovid EMBASE (2008 to 2010 Week 42), EBSCO CINAHL (2008 to 5 October 2010) 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 people undergoing surgery.

Data collection and analysis

Two review authors independently assessed studies for selection, quality and extracted data. Study authors were contacted for additional information.

Main results

No new trials were included in this third update. Seven trials involving a total of 10,157 participants were included. Four of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub/Riohex). Three trials involving 7791 participants compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with placebo did not result in a statistically significant reduction in SSIs; the relative risk of SSI (RR) was 0.91 (95% confidence interval (CI) 0.80 to 1.04). When only trials of high quality were included in this comparison, the RR of SSI was 0.95 (95%CI 0.82 to 1.10). Three trials of 1443 participants compared bar soap with chlorhexidine; when combined there was no difference in the risk of SSIs (RR 1.02, 95% CI 0.57 to 1.84). Three trials of 1192 patients compared bathing with chlorhexidine with no washing, one large study found a statistically significant difference in favour of bathing with chlorhexidine (RR 0.36, 95%CI 0.17 to 0.79). The smaller studies found no difference between patients who washed with chlorhexidine and those who did not wash preoperatively.

Authors' conclusions

This review provides no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated.

 

Plain language summary

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

Surgical site infection is a serious complication of surgery and is usually associated with increased length of hospital stay for the patient, and also higher hospital costs. The use of an antiseptic solution for preoperative bathing or showering is widely practiced in the belief that it will help to prevent surgical site infections from developing. This review identified seven trials, with over 10,000 patients, that tested skin antiseptics (chlorhexidine solution) against normal soap or no presurgical washing. The review of these trials did not show clear evidence that the use of chlorhexidine solution before surgery was better than other wash products at preventing surgical site infections from developing after surgery.

 

摘要

背景

在手術前使用抗菌劑沐浴或淋浴來預防手術部位感染

手術部位感染(Surgical site infections (SSIs))是指發生在侵入性程序(手術)後的傷口感染。在手術前使用抗菌劑沐浴或淋浴來減少皮膚上的細菌數(微生物)，是一種大家都知道的方法，但是我們不是很清楚減少皮膚上的微生物，是否可以降低手術部位感染的發生率。

目標

在手術前使用抗菌劑沐浴或淋浴來預防院內的手術部位感染

搜尋策略

我們搜尋了Cochrane Wounds Group Specialised Register(2005年12月)，也搜尋了Cochrane Central Register of Controlled Trials (The Cochrane Library 2005年第4期) ，同時搜尋了MEDLINE(從1966年12月到2005)以及參考資料中的文獻。

選擇標準

比對病人在手術前使用任何抗菌劑進行全身沐浴或淋浴，以及沒有使用任何抗菌劑但一樣有進行全身沐浴或淋浴的手術前準備的隨機對照臨床試驗。

資料收集與分析

2位評論作家分別獨立的評估選擇試驗的品質以及摘錄數據，也聯絡了論文的作者以便取得額外的資訊。

主要結論

我們納入了6個一共有10007位受試者的臨床試驗，其中3個臨床試驗有3個對照的組別，所有的組別都使用4% chlorhexidine gluconate (Hibiscrub) 。有3個一共納入7691位受試者的臨床試驗比對了chlorhexidine以及安慰劑，結果發現使用chlorhexidine沐浴並沒有統計學上的降低手術部位感染的意義，手術部位感染的相對風險(RR)為0.91(95% 信賴區間confidence interval (CI) 0.80到1.04)。有3個總共納入1443位病人的臨床試驗，來比對一般肥皂以及chlorhexidine，當2者併用時，手術部位感染的風險並沒有改變(RR 1.02, 95% CI 0.57 to 1.84)。有2個納入1092位病人的臨床試驗比對使用chlorhexidine沐浴以及沒有做任何清潔的工作，其中大型的研究發現一個統計學上重要的意義，支持實驗組(以chlorhexidine沐浴)(RR 0.36, 95% CI 0.17 to 0.79)。規模較小的研究中發現，是否在手術前使用chlorhexidine沐浴，對預防手術部位感染並沒有特別的效用。

作者結論

這一篇評論沒有提供明確的證據，來證明在手術前使用chlorhexidine沐浴或淋浴比用其他的清潔產品，更能降低手術部位感染。降低醫院手術部位感染的發生率，應該要把焦點放在已經被印證過有影響的介入措施。

翻譯人

本摘要由成功大學附設醫院蔡佩蓉翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

對於是否在手術前使用chlorhexidine沐浴或淋浴來預防手術部位感染不是很清楚，手術部位感染是一種手術後很嚴重的合併症，也許跟病人在手術後住院時間的延長以及住院費用的增加有關。在手術前使用抗菌劑沐浴或淋浴來預防手術部位感染，是一種廣被接受的理論。然而這篇評論發現在6個一共納入超過10000位病人的臨床試驗中，chlorhexidine溶跟其他清潔產品比較後，並沒有發現明確的證據可以證明它的效用。