Format

Send to

Choose Destination
Surg Infect (Larchmt). 2015 Feb;16(1):14-23. doi: 10.1089/sur.2015.010.

Skin preparation before surgery: options and evidence.

Author information

1
1 Boston University School of Medicine , Boston, Massachusetts.

Abstract

BACKGROUND:

Despite many advances in surgical asepsis, surgical site infection (SSI) remains a challenging and costly problem. Decontamination of the skin with an antiseptic agent is standard practice before any trans-cutaneous invasive procedure, but the antiseptic agent of choice to best reduce the risk of SSI remains controversial.

METHODS:

Review of relevant literature.

RESULTS:

Many randomized controlled trials (RCTs) have evaluated chlorhexidine-based and iodine-based preparation solutions, with and without an alcohol component. Most of these trials are underpowered to detect differences in SSI rates. The largest modern RCT showed that a chlorhexidine-isopropyl alcohol preparation reduced the risk of SSI substantially compared with a povidone-iodine preparation without alcohol in clean-contaminated surgery. Many smaller RCTs have shown that chlorhexidine-isopropyl alcohol is superior to povidone-iodine plus isopropyl alcohol or iodine povacrylex plus isopropyl alcohol in pre-operative skin decontamination; whether or not this translates into lower SSI rates is unknown. A mixed treatment comparison of 10 RCTs concluded that alcohol-based preparations have a 98% probability of reducing the risk of SSI more effectively than aqueous-based preparations. Non-randomized observational studies have generally found no difference in SSI rates among various skin antiseptic preparations.

CONCLUSIONS:

Alcohol-based agents are likely superior to aqueous agents. Chlorhexidine may decrease SSI rates compared with povidone-iodine, and chlorhexidine-isopropyl alcohol likely offers better skin decontamination before clean surgery than povidone-iodine plus isopropyl alcohol or iodine povacrylex plus isopropyl alcohol. The quality of the available data is moderate. Rigorous, well-powered RCTs with appropriate treatment comparisons are needed to establish the optimal and most cost-effective pre-operative skin preparation in various operations and wound classifications.

PMID:
25761076
DOI:
10.1089/sur.2015.010
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center