Intervention Review

Cyanoacrylate microbial sealants for skin preparation prior to surgery

  1. Allyson Lipp1,*,
  2. Cheryl Phillips2,
  3. Paul Harris3,
  4. Iwan Dowie2

Editorial Group: Cochrane Wounds Group

Published Online: 21 AUG 2013

Assessed as up-to-date: 3 JUL 2013

DOI: 10.1002/14651858.CD008062.pub3

How to Cite

Lipp A, Phillips C, Harris P, Dowie I. Cyanoacrylate microbial sealants for skin preparation prior to surgery. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD008062. DOI: 10.1002/14651858.CD008062.pub3.

Author Information

  1. 1

    Department of Care Sciences, University of South Wales, Faculty of Health, Sport and Science, Pontypridd, Rhondda Cynon Taff, UK

  2. 2

    Department of Care Sciences, University of Glamorgan, Faculty of Health, Sport and Science, Pontypridd, Rhondda Cynon Taff, UK

  3. 3

    Princess of Wales Hospital, Abertawe Bro Morgannwg University NHS Trust, Main Theatres, Bridgend, UK

*Allyson Lipp, Faculty of Health, Sport and Science, Department of Care Sciences, University of South Wales, Glyn Taff Campus, Pontypridd, Rhondda Cynon Taff, CF37 1DL, UK. allyson.lipp@southwales.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 21 AUG 2013

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Surgical site infections (i.e. incisions that become infected) are a continuing concern in health care. Microbial sealant is a liquid that can be applied to the skin immediately before surgery and is thought to help reduce the incidence of surgical site infections (SSIs) by sealing in the skin flora, thus preventing contamination and infection of the surgical site.

Objectives

To assess the effects of the preoperative application of microbial sealants (compared with no microbial sealant) on rates of SSI in people undergoing clean surgery.

Search methods

For this first update we searched the following electronic databases in July 2013: the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE - In-Process & Other Non-Indexed Citations, Ovid EMBASE and EBSCO CINAHL.

Selection criteria

Randomised controlled trials (RCTs) were eligible for inclusion if they involved people undergoing clean surgery (i.e. surgery that does not involve the breathing system, gut, genital or urinary tract or any part of the body with an existing infection) in an operating theatre and compared the use of preoperative microbial sealants with no microbial sealant.

Data collection and analysis

All review authors independently extracted data on the characteristics, risk of bias and outcomes of the eligible trials.

Main results

Three trials (524 participants undergoing clean surgery) met the inclusion criteria. The trials all compared cyanoacrylate microbial sealant with no sealant, and, when pooled, we found there were fewer SSIs with the use of microbial sealant (10/261 participants) than with the control comparison (29/274 participants). The difference between the two groups was statistically significant (risk ratio (RR) 0.36, 95% CI 0.18 to 0.72) but given the number of participants and quality of the studies, they should be treated with caution. There were some adverse events in one study, but these were not judged to be a result of the use of microbial sealant.

Authors' conclusions

In this first update there is still insufficient evidence available to determine whether the use of microbial sealants reduces the risk of surgical site infection or not. Further rigorous, adequately-powered RCTs are required to investigate this properly.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Cyanoacrylate microbial sealants for skin preparation prior to surgery

Surgical site infection (SSI) is a serious complication of surgery. Microbial sealant is a liquid applied to the surface of the skin immediately before surgery to seal in any bacteria living on the skin that may pose a risk of infection. Before applying the sealant, the skin at the operating site is usually prepared with an antiseptic solution of 10% povidone-iodine. Our searches discovered three eligible randomised trials, with a total of 524 participants, that compared the impact of sealant compared with no sealant on the incidence of SSIs. Two trials concerned cardiac surgery, and the third concerned inguinal hernia repair. When the results of the trials were combined they did produce a statistically significant difference in SSI rates, however, the evidence from the trials was not of high quality, so further research is needed to find out whether this intervention works.