Gaetano Pierpaolo Privitera1, Anna Laura Costa2, Silvio Brusaferro3, Piero Chirletti4, Paola Crosasso5, Gabriele Massimetti6, Angelo Nespoli7, Nicola Petrosillo8, Mauro Pittiruti9, Giancarlo Scoppettuolo10, Fabio Tumietto11, Pierluigi Viale12. 1. Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy. Electronic address: gaetano.privitera@med.unipi.it. 2. Università di Pisa, Pisa, Italy. 3. Dipartimento di Scienze Mediche e Biologiche, Università di Udine, Udine, Italy. 4. Dipartimento di Scienze Chirurgiche, Università degli Studi di Roma La Sapienza, Rome, Italy. 5. S.C. Farmacia Laboratorio Galenici-Sperimentazioni Cliniche-Farmacovigilanza e Diagnostici, Az. Ospedaliera Città della Salute e della Scienza, Torino, Italy. 6. Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy. 7. Dipartimento di Scienze Chirurgiche, Università degli Studi di Milano Bicocca, Milan, Italy. 8. Dipartimento Clinico e di Ricerca in Malattie Infettive, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani", IRCCS, Rome, Italy. 9. Dipartimento di Scienze Chirurgiche, Università Cattolica del Sacro Cuore, Rome, Italy. 10. Unità di Consulenza Infettivologica Integrata, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy. 11. Unità Operativa Malattie Infettive, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy. 12. Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
Abstract
BACKGROUND: Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions. PURPOSE: To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates. PROCEDURES: We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization. RESULTS: Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95% CI, 0.36-0.55). CONCLUSIONS: There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery.
BACKGROUND: Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions. PURPOSE: To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates. PROCEDURES: We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization. RESULTS: Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95% CI, 0.36-0.55). CONCLUSIONS: There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery.
Authors: Allen G Strickler; Payal Shah; Shirin Bajaj; Richard Mizuguchi; Rajiv I Nijhawan; Mercy Odueyungbo; Anthony Rossi; Désirée Ratner Journal: J Am Acad Dermatol Date: 2021-01-23 Impact factor: 15.487
Authors: A Charehbili; M B G Koek; J C A de Mol van Otterloo; M W G A Bronkhorst; P van der Zwaal; B Thomassen; E J Waasdorp; J A Govaert; A Bosman; J van den Bremer; A J Ploeg; H Putter; A P Meijs; C J H van de Velde; W van Gijn; R J Swijnenburg Journal: BJS Open Date: 2019-05-20
Authors: Peter F Duckworth; Sarah E Maddocks; Sameer S Rahatekar; Michele E Barbour Journal: J Mater Sci Mater Med Date: 2020-03-11 Impact factor: 3.896