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

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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 third update we searched the Cochrane Wounds Group Specialised Register (searched 5 November 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2010), Ovid MEDLINE (January 2008 to November Week 2 2010), Ovid EMBASE (2008 to 2010 Week 42), EBSCO CINAHL (2008 to 5 October 2010) 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, quality and extracted data. Study authors were contacted for additional information. Main results No new trials were included in this third 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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