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Evid Based Nurs 9:116 doi:10.1136/ebn.9.4.116
  • Treatment

Review: full body washing with skin antiseptics before surgery does not prevent surgical site infection


 
 Q Does full body washing with skin antiseptics before surgery prevent surgical site infection?

METHODS

GraphicData sources:

Medline (2005), Cochrane Wounds Group Specialised Register (2005) (includes searches of Medline, CINAHL, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, wound care journals, and relevant conference proceedings), reference lists of retrieved articles, and manufacturers of antiseptic products.

GraphicStudy selection and assessment:

randomised controlled trials (RCTs) that compared preoperative full body bathing or showering using antiseptic solution with use of non-antiseptic soap or no full body wash in adults or children undergoing any type of surgery. 6 RCTs (n = 10 007) met the selection criteria. The antiseptic used in all trials was 4% chlorhexidine gluconate. Quality of RCTs was independently assessed by 2 reviewers based on randomisation method, allocation concealment, blinding, intention to treat analysis, and completeness of outcome reporting.

GraphicOutcomes:

surgical site infection (as defined in the original study), allergic reactions, costs.

MAIN RESULTS

Full body washing with chlorhexidine did not reduce the risk of surgical site infection more than full body washing with placebo or bar soap, or no shower or bath (table). In 1 RCT, full body washing with chlorhexidine reduced the risk of surgical site infection more than localised washing of the surgical site with chlorhexidine (table). 1 study (n = 3489) reported no difference between chlorhexidine and placebo for allergic reactions or overall costs.

CONCLUSION

Full body washing with skin antiseptics (4% chlorhexidine) before surgery does not prevent surgical site infection.

Commentary

  1. Jacqui Fernell, RN, BEd, MA
  1. University of Worcester
 Worcester, UK

      It is self evident that personal hygiene and washing reduces the risk of infection.1 Supporting evidence has been provided by the many research studies that have evaluated preoperative skin preparation.2 Even so, surgical site infection is still a far too common occurrence in hospitals, accounting for about 14–16% of nosocomial infections.3 In today’s healthcare service, prevention of acquired infection is paramount, not only to ensure patient wellbeing, but also in light of public opinion, media attention, government drivers, and financial constraints.

      The coherent and comprehensive systematic review by Webster and Osborne is timely and has implications for practice. The review was well conducted and clearly reported, fulfilling the criteria for a good quality systematic review. The authors completed a thorough search of existing literature and reviewed relevant trials. They gave a clear rationale for the selection of trials and explained each step of the review process clearly. All RCTs included in the review evaluated preoperative washing with chlorhexidine, although trials differed in the control treatment used. These separate comparisons provide useful information about the effects of various methods of washing but, because trials with different control treatments were not combined into a single meta-analysis, a common conclusion can not reliably be drawn. Overall, however, the large sample sizes involved and the rigour of the systematic review ensure that appropriate analyses were undertaken and meaningful results presented.

      The conclusion of the review by Webster and Osborne is that full body washing with an antiseptic, specifically chlorhexidine, is no more effective in preventing surgical site infection than washing with ordinary soap. Discontinuing use of chlorhexidine could result in a reduction in costs, although 1 study found no significant difference in cost between antiseptic and placebo. Infection control principles remain important when preparing patients for surgery. The finding that different types of cleansing agents are similarly effective suggests that the choice of a specific agent can reflect patient preference and resource availability.

      References

      Preoperative full body washing with chlorhexidine v control to prevent surgical site infection at ⩽6 weeks*

      
 
 Q Does full body washing with skin antiseptics before surgery prevent surgical site infection?

      Footnotes

      • For correspondence: MsJ Webster, Royal Brisbane and Royal Women’s Hospital, Herston, Queensland, Australia. joan_webster{at}health.qld.gov.au

      • Source of funding: no external funding.

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