Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: a systematic review.

BACKGROUND Postoperative surgical site infections (SSI) are the third most common health care associated infection. Even though several studies have pointed out the benefits of disinfection showers prior to surgery in order to reduce SSI, it remains unclear how to optimize this disinfection procedure. AIM To find evidence for how many times preoperative disinfection showers should be performed in order to reduce bacterial colonies and minimize the risk of SSI. METHOD A comprehensive literature search of multiple databases published during 1986-2008, supplemented by a manual search of the references in all relevant articles. Protocols were used in quality assessment and the data synthesis is descriptive in a narrative form. RESULTS The 10 studies included had different designs, interventions, and samples, which makes it difficult to compare them. Moreover, the quality of the reviewed studies varied and only four had a high level of evidence. Therefore, the results failed to give an unambiguous answer about the optimal number of preoperative showers, so only assumptions can be made. It is quite obvious, however, that preoperative disinfection showers with chlorhexidine gluconate (CHG) are effective from a microbiological point of view since eight of the reviewed studies showed a sharply reduced skin flora after using CHG. CONCLUSIONS Currently, clear evidence for how many times preoperative disinfection showers should be performed to minimize the risk of SSI is missing. This highlights the need for further research that focuses on the number of preoperative disinfection showers in relation to SSI, in order to obtain optimal effect. Until then, it would be wise to follow previously made recommendation of three to five preoperative showers. Moreover, in order to have the intended effect of preoperative disinfection, it is important that health care professionals have the knowledge to guide patients with information and clear instructions about disinfection shower procedures.