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

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 the prevention of hospital-acquired (nosocomial) surgical site infection. Search strategy We searched the Cochrane Wounds Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE (January 1966 to December 2005) and reference lists of articles. Selection criteria Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with nonantiseptic preparations in patients undergoing surgery. Data collection and analysis Two authors independently assessed studies for selection, trial quality and extracted data. Study authors were contacted for additional information. Main results Six trials involving a total of 10,007 participants were included. Three of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub). Three trials involving 7691 participants compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with a 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 0.10). 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). Two trials of 1092 patients compared bathing with chlorhexidine with no washing. No difference was found in the postoperative SSI rate between patients who washed with chlorhexidine and those who did not wash preoperatively (RR 0.70, 95% CI 0.19 to 2.58). Authors’ conclusions This review provides evidence of no 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. 1 Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (Review) Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd P L A I N L A N G U A G E S U M M A R Y Using chlorhexidine for preoperative bathing or showering is unlikely to prevent surgical site infection. Surgical site infection is a serious complication of surgery and may be associated with increased length of hospital stay for the patient and higher hospital costs. The use of an antiseptic solution for pre-operative bathing or showering is widely practiced in the belief that it will help to prevent surgical site infection. However, the review found six trials that included over 10,000 patients that did not show any evidence of benefit for the use an antiseptic solution over other wash products.