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Meta-Analysis
. 2015 Feb 20;2015(2):CD004985.
doi: 10.1002/14651858.CD004985.pub5.

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

Joan Webster  1 , Sonya Osborne
Affiliations
Meta-Analysis

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

Joan Webster et al. Cochrane Database Syst Rev. .

Abstract

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 preventing hospital-acquired (nosocomial) surgical site infections.

Search methods: For this fifth update we searched the Cochrane Wounds Group Specialised Register (searched 18 December 2014); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014 Issue 11); Ovid MEDLINE (2012 to December Week 4 2014), Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 18, 2014); Ovid EMBASE (2012 to 2014 Week 51), EBSCO CINAHL (2012 to December 18 2014) and reference lists of articles.

Selection criteria: Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in people undergoing surgery.

Data collection and analysis: Two review authors independently assessed studies for selection, risk of bias and extracted data. Study authors were contacted for additional information.

Main results: We did not identify any new trials for inclusion in this fifth update. Seven trials involving a total of 10,157 participants were included. Four of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub/Riohex). Three trials involving 7791 participants compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with 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 1.10). 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). Three trials of 1192 patients compared bathing with chlorhexidine with no washing, one large study found a statistically significant difference in favour of bathing with chlorhexidine (RR 0.36, 95%CI 0.17 to 0.79). The smaller studies found no difference between patients who washed with chlorhexidine and those who did not wash preoperatively.

Authors' conclusions: This review provides no clear evidence of 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.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Chlorhexidine 4% versus placebo, Outcome 1 Surgical site infection.
1.2
1.2. Analysis
Comparison 1 Chlorhexidine 4% versus placebo, Outcome 2 Surgical site infection (high quality studies).
1.3
1.3. Analysis
Comparison 1 Chlorhexidine 4% versus placebo, Outcome 3 Allergic reaction.
2.1
2.1. Analysis
Comparison 2 Chlorhexidine 4% versus bar soap, Outcome 1 Surgical site infection.
3.1
3.1. Analysis
Comparison 3 Chlorhexadine 4% versus no wash, Outcome 1 Surgical site infection.
4.1
4.1. Analysis
Comparison 4 Chlorhexidine full wash versus partial wash, Outcome 1 Surgical site infection.
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