Early versus delayed post-operative bathing or showering to prevent wound complications
Editorial Group: Cochrane Wounds Group
Published Online: 12 OCT 2013
Assessed as up-to-date: 3 JUL 2013
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Toon CD, Sinha S, Davidson BR, Gurusamy KS. Early versus delayed post-operative bathing or showering to prevent wound complications. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD010075. DOI: 10.1002/14651858.CD010075.pub2.
- Publication Status: New
- Published Online: 12 OCT 2013
Many people undergo surgical operations during their life-time, which result in surgical wounds. After an operation the incision is closed using stiches, staples, steri-strips or an adhesive glue. Usually, towards the end of the surgical procedure and before the patient leaves the operating theatre, the surgeon covers the closed surgical wound using gauze and adhesive tape or an adhesive tape containing a pad (a wound dressing) that covers the surgical wound. There is currently no guidance about when the wound can be made wet by post-operative bathing or showering. Early bathing may encourage early mobilisation of the patient, which is good after most types of operation. Avoiding post-operative bathing or showering for two to three days may result in accumulation of sweat and dirt on the body. Conversely, early washing of the surgical wound may have an adverse effect on healing, for example by irritating or macerating the wound, and disturbing the healing environment.
To compare the benefits (such as potential improvements to quality of life) and harms (potentially increased wound-related morbidity) of early post-operative bathing or showering (i.e. within 48 hours after surgery, the period during which epithelialisation of the wound occurs) compared with delayed post-operative bathing or showering (i.e. no bathing or showering for over 48 hours after surgery) in patients with closed surgical wounds.
We searched The Cochrane Wounds Group Specialised Register;The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); The Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; EBSCO CINAHL; the metaRegister of Controlled Trials (mRCT) and the International Clinical Trials Registry Platform (ICTRP).
We considered all randomised trials conducted in patients who had undergone any surgical procedure and had surgical closure of their wounds, irrespective of the location of the wound and whether or not the wound was dressed. We excluded trials if they included patients with contaminated, dirty or infected wounds and those that included open wounds. We also excluded quasi-randomised trials, cohort studies and case-control studies.
Data collection and analysis
We extracted data on the characteristics of the patients included in the trials, risk of bias in the trials and outcomes from each trial. For binary outcomes, we calculated the risk ratio (RR) with 95% confidence interval (CI). For continuous variables we planned to calculate the mean difference (MD), or standardised mean difference (SMD) with 95% CI. For count data outcomes, we planned to calculate the rate ratio (RaR) with 95% CI. We used RevMan 5 software for performing these calculations.
Only one trial was identified for inclusion in this review. This trial was at a high risk of bias. This trial included 857 patients undergoing minor skin excision surgery in the primary care setting. The wounds were sutured after the excision. Patients were randomised to early post-operative bathing (dressing to be removed after 12 hours and normal bathing resumed) (n = 415) or delayed post-operative bathing (dressing to be retained for at least 48 hours before removal and resumption of normal bathing) (n = 442). The only outcome of interest reported in this trial was surgical site infection (SSI). There was no statistically significant difference in the proportion of patients who developed SSIs between the two groups (857 patients; RR 0.96; 95% CI 0.62 to 1.48). The proportions of patients who developed SSIs were 8.5% in the early bathing group and 8.8% in the delayed bathing group.
There is currently no conclusive evidence available from randomised trials regarding the benefits or harms of early versus delayed post-operative showering or bathing for the prevention of wound complications, as the confidence intervals around the point estimate are wide, and, therefore, a clinically significant increase or decrease in SSI by early post-operative bathing cannot be ruled out. We recommend running further randomised controlled trials to compare early versus delayed post-operative showering or bathing.
Plain language summary
Post-operative bathing and showering to prevent wound complications
Many people undergo surgical operations during their life-time. After an operation the surgical wound is closed using stiches, staples, tape (steri-strips) or an adhesive glue. Usually, towards the end of the surgical procedure and before the person leaves the operating theatre, the surgeon covers the closed surgical wound using gauze and adhesive tape, or an adhesive tape containing a pad that covers the surgical wound. This is called a wound dressing. There is currently no guidance about when wounds can be made wet by bathing or showering post-operatively. Early bathing may encourage the person to move about, which is good after most types of surgery. Avoiding post-operative bathing or showering for two to three days may result in the accumulation of sweat and dirt on the body, but early washing of the wound may have a bad effect on healing by irritating the wound and disturbing the healing environment. We reviewed all the available evidence from the medical literature (up to July 2013) on this issue. In particular, we sought information from randomised controlled trials, which, if conducted well, provide the most accurate information.
We identified only one randomised controlled trial. This trial was at high risk of bias, i.e. there were flaws in the way it was conducted that could have given incorrect results.This trial included 857 people undergoing minor skin operations performed at a General Practitioner (GP) surgery. No steri-strips were used in this trial, as the wounds were stitched. The people running the trial used a method similar to the toss of a coin to decide which group participants went into. One group of 415 people was advised to remove the dressing 12 hours after surgery and then to bathe normally, while the other group of 442 people was advised to keep the dressing on for at least 48 hours and then to bathe normally. The only outcome of interest reported in this trial was wound infection. The authors reported no statistically significant difference in the proportion of people who developed wound infection in the two groups (8.5% in the early bathing group and 8.8% in the delayed bathing group).
There is currently no conclusive evidence available from randomised trials about the benefits, or harms, with regard to wound complications of early or delayed post-operative showering or bathing. We recommend further randomised controlled trials to compare early versus delayed post-operative showering or bathing.