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Intervention Review

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Early versus delayed post-operative bathing or showering to prevent wound complications

  1. Clare D Toon1,
  2. Sidhartha Sinha2,
  3. Brian R Davidson3,
  4. Kurinchi Selvan Gurusamy3,*

Editorial Group: Cochrane Wounds Group

Published Online: 12 OCT 2013

Assessed as up-to-date: 3 JUL 2013

DOI: 10.1002/14651858.CD010075.pub2


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.

Author Information

  1. 1

    West Sussex County Council, Public Health, Chichester, West Sussex, UK

  2. 2

    St George's Hospital, St George's Vascular Institute, London, UK

  3. 3

    Royal Free Campus, UCL Medical School, Department of Surgery, London, UK

*Kurinchi Selvan Gurusamy, Department of Surgery, Royal Free Campus, UCL Medical School, Pond Street, London, NW3 2QG, UK. kurinchi2k@hotmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 12 OCT 2013

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This is not the most recent version of the article. View current version (23 JUL 2015)

 
Characteristics of included studies [ordered by study ID]
Heal 2006

MethodsRandomised clinical trial


ParticipantsCountry: Australia
Number randomised: 870
Post-randomisation drop-outs: 13 (1.5%)
Revised sample size: 857
Average age: 56 years
Male:female numbers: 457 (51.8%): 413 (48.2%)
Inclusion criteria:
People who presented to a participating general practitioner for a minor skin excision
Exclusion criteria:
1. Excisions on the face
2. Taking oral antibiotics
3. Immediate clinical indication for oral or topical antibiotics post-operatively
4. On immunosuppressive drugs
5. Lacerations
6. A flap, or 2-layer procedure
7. Excision of a sebaceous cyst


InterventionsParticipants were randomly assigned to 2 groups
Group 1: Early post-operative bathing or showering (n = 415), dressing to be removed within 12 hours and normal bathing resumed (420 participants were randomised. Five participants were excluded because of loss to follow-up)

Group 2: Delayed post-operative bathing or showering (n = 442), dressing to be retained for at least 48 hours, then removed, and normal bathing to resume (450 participants were randomised. Eight participants were excluded because of loss to follow-up)

Other details: Wounds were sutured in both groups and both groups were asked not to use antiseptic washes or soaps

Dressing type: melolin and tape


OutcomesSSI


NotesWe attempted to contact the authors in January 2013

Source of funding: quote: "Research was funded by a novice research scholarship from the primary health care research and development fund. The authors’ work is independent of this funding"

Declaration of interests: none


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskQuote: "After agreeing to participate, patients were randomised by picking a ball out of a hat"

Comment: The number of balls in the hat, whether the patient blindfolded, and whether the researcher involved in this process aware of the clinical details about the patient before ball was picked were not reported. All these may influence the randomisation process

Allocation concealment (selection bias)Unclear riskQuote: "After agreeing to participate, patients were randomised by picking a ball out of a hat"

Comment: The number of balls in the hat, whether the patient blindfolded, and whether the researcher involved in this process aware of the clinical details about the patient before ball was picked were not reported. All these may influence the randomisation process

Blinding of participants and personnel (performance bias)
All outcomes
High riskQuote: "No blinding took place"

Blinding of outcome assessment (detection bias)
All outcomes
High riskQuote: "No blinding took place"

Incomplete outcome data (attrition bias)
All outcomes
Low riskQuote: "A total of 13 patients were eventually lost to follow-up"

Comment: imputation using different scenarios did not alter the conclusions. This shows that the missing data did not affect the conclusions of the study

Selective reporting (reporting bias)Unclear riskComment: the trial protocol was not available and all the primary outcomes of this review were not reported in this trial

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Betts 2006Comment on a report

Fraser 1976Shower or bathing allowed after 3 days in the trial's early intervention group, but, according to the definitions used in this review, both groups belong to the delayed group

Neues 2000Before and after study

Riederer 1997Quasi-randomised study (alternate allocation)

Voorhees 1982Quasi-randomised study (allocation by social security number)

 
Comparison 1. Early versus delayed post-operative bathing and showering

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Surgical site infection1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 2 Surgical site infection (sensitivity analysis)1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    2.1 Best-best scenario
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.2 Best-worst scenario
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.3 Worst-best scenario
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.4 Worst-worst scenario
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Summary of findings for the main comparison. Early versus delayed post-operative bathing and showering

Early versus delayed post-operative bathing and showering

Patient or population: patients with closed post-operative incisions
Setting: primary care
Intervention: early post-operative bathing and showering

Control: delayed post-operative bathing and showering

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

Control (delayed post-operative bathing and showering)Early post-operative bathing and showering

Surgical site infection88 per 100085 per 1000
(55 to 131)
RR 0.96
(0.62 to 1.48)
857
(1 study)
⊕⊝⊝⊝
very low1,2,3,4

*The basis for the assumed risk is the control group risk in the study. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: we are very uncertain about the estimate

 1 The trial was of high risk of bias
2 Confidence intervals overlaps 1 and 0.75 or 1.25
3 The total number of events was fewer than 300
4 There were too few trials to assess publication bias