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Kamel C, McGahan L, Mierzwinski-Urban M, et al. Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections: A Systematic Review of the Clinical Evidence and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2011 Jun.

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Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections: A Systematic Review of the Clinical Evidence and Guidelines [Internet].

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4.1. Literature Search

An information specialist performed the literature search using a peer-reviewed search strategy.

Published literature was identified by searching the following bibliographic databases: MEDLINE with in-process records and daily updates via Ovid; Embase; EBM Reviews — Cochrane Central Register of Controlled Trials 4th Quarter 2010 via Ovid; EBM Reviews — Cochrane Database of Systematic Reviews via Ovid; EBM Reviews — Database of Abstracts of Reviews of Effects 1st Quarter 2011 via Ovid; EBM Reviews — Health Technology Assessment 1st Quarter 2011 via Ovid; CINAHL via EBSCO; and PubMed. The search strategy consisted of controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. The main search concepts were preoperative and skin preparation.

Methodological filters were applied to limit retrieval to health technology assessments, systematic reviews, meta-analyses, randomized controlled trials (RCTs), non-randomized controlled clinical trials, and guidelines. Where possible, retrieval was limited to the human population. The search was also limited to English language documents published between January 1, 2001, and February 9, 2011. Regular alerts were established to update the search until June 2, 2011. See Appendix 2 for the detailed search strategies.

Grey literature (literature that is not commercially published) was identified by searching relevant sections of the Grey Matters checklist ( Google and other Internet search engines were used to search for additional materials. These searches were supplemented by reviewing the bibliographies of key papers and through contacts with appropriate experts and industry. See Appendix 2 for more information on the grey literature search strategy.

4.2. Selection Criteria and Methods

Two reviewers (CK and LM) independently screened citations and selected RCTs, non-randomized studies, and clinical practice guidelines on preoperative skin antiseptic preparations and application techniques for preventing surgical site infections. The decision to order a full-text article was based on the title and abstract, where available. In cases where there was insufficient information, the article was ordered. Two reviewers (CK and LM) selected articles for inclusion in the review based on full-text publications. A study or guideline was included for review based on the selection criteria that were established before the research was started (Table 1 and Appendix 3). Any disagreement between reviewers was discussed until consensus was reached. The references of HTAs, systematic reviews, and meta-analyses were searched for any trials that could have been missed in the literature search

Table 1. Selection Criteria.

Table 1

Selection Criteria.

4.3. Exclusion Criteria

Studies were excluded if they did not meet the selection criteria; had an incomplete methods section; presented preliminary results in abstract form; were duplicate publications, narrative reviews, or editorials; or were published before 2001.

4.4. Data Extraction Strategy

Two reviewers (CK and LM) piloted data extraction forms before the research began. In addition, they independently extracted the clinical effectiveness and clinical practice guidelines data for each article using data extraction forms to tabulate relevant characteristics and outcomes from the included studies. A calibration exercise using one RCT and one non-randomized study was undertaken to ensure consistency between reviewers. A template of the form that was used for data extraction appears in Appendix 4.

4.5. Critical Appraisal of Individual Studies

Two reviewers (CK and LM) independently evaluated the quality of RCTs and non-randomized studies using a Downs and Black instrument9 that was modified to include the source of funding for studies. The methodological quality of clinical effectiveness evidence was assessed based on randomization, adequate concealment of randomization, degree of blinding, use of intention-to-treat analysis, and description of dropouts and withdrawals, where appropriate. A numeric score was not calculated for each study. Instead, the strengths and weaknesses were described. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument10 was used to appraise clinical practice guidelines. The domains assessed were scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, and editorial independence. These domains are described in Appendix 5. Any disagreements were resolved through discussion until consensus was reached. A calibration exercise to ensure consistency between reviewers was performed using one RCT and one non-randomized study. The template forms used for study quality assessment appear in Appendix 6.

4.6. Data Analysis Methods

Because of clinical heterogeneity across the selected studies, a formal meta-analysis was not conducted. The studies are described using a narrative approach in response to each research question.

Copyright © CADTH (June 2011)

You are permitted to make copies of this document for non-commercial purposes provided it is not modified when reproduced and appropriate credit is given to CADTH.

Links: This document may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third-party sites is governed by the owners’ own terms and conditions set out for such sites. CADTH does not make any guarantee with respect to any information contained on such third-party sites and CADTH is not responsible for any injury, loss, or damage suffered as a result of using such third-party sites.

Industry: The following manufacturers were provided with an opportunity to comment on an earlier version of this report: 3M Canada, AstraZeneca Canada Inc., CareFusion. All comments that were received were considered when preparing the final report.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at

Bookshelf ID: NBK174552


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