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

Article

Webster, J. and Osborne, S.. 2006. "Preoperative bathing or showering with skin antiseptics to prevent surgical site infection [Review]." Cochrane Database of Systematic Reviews. 2006 (2), pp. 1-23.
Article Title

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

ERA Journal ID15305
Article CategoryArticle
AuthorsWebster, J. (Author) and Osborne, S. (Author)
Journal TitleCochrane Database of Systematic Reviews
Journal Citation2006 (2), pp. 1-23
Article NumberCD004985
Number of Pages23
Year2006
PublisherJohn Wiley & Sons
Place of PublicationUnited Kingdom
ISSN1469-493X
1361-6137
Web Address (URL)http://www.scopus.com/inward/record.url?eid=2-s2.0-33745023612&partnerID=MN8TOARS
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 the prevention of hospital-acquired (nosocomial) surgical site infection.

Search strategy
We searched the Cochrane Wounds Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE (January 1966 to December 2005) 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 patients undergoing surgery.

Data collection and analysis
Two authors independently assessed studies for selection, trial quality and extracted data. Study authors were contacted for additional information.

Main results
Six trials involving a total of 10,007 participants were included. Three of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub). Three trials involving 7691 participants compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with a 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 0.10). 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). Two trials of 1092 patients compared bathing with chlorhexidine with no washing. No difference was found in the postoperative SSI rate between patients who washed with chlorhexidine and those who did not wash preoperatively (RR 0.70, 95% CI 0.19 to 2.58).

Authors’ conclusions
This review provides evidence of no 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.

ANZSRC Field of Research 2020420501. Acute care
Public Notes

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Byline AffiliationsDepartment of Health, Queensland
Institution of OriginUniversity of Southern Queensland
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The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: a cross sectional study
Osborne, Sonya, Douglas, Clint, Reid, Carol, Jones, Lee and Gardner, Glenn. 2015. "The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: a cross sectional study." International Journal of Nursing Studies. 52 (5), pp. 951-962. https://doi.org/10.1016/j.ijnurstu.2015.01.014
Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (Review)
Webster, Joan and Osborne, Sonya. 2015. "Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (Review)." Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004985.pub5
Perioperative nursing
Sutherland-Fraser, Sally, Osborne, Sonya and Bryant, Kim. 2016. "Perioperative nursing." Hamlin, Lois, Davies, Menna, Richardson-Tench, Marilyn and Sutherland-Fraser, Sally (ed.) Perioperative nursing: an introduction. Marrickville, Australia. Elsevier. pp. 1-29
Author response: missed opportunity related to statistical methods
Osborne, Sonya Ranee, Jones, Lee and Webster, Joan. 2014. "Author response: missed opportunity related to statistical methods." AORN Journal. 99 (6), pp. 675-677. https://doi.org/10.1016/j.aorn.2014.04.002
Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients
Stankiewicz, Monica, Coyer, Fiona, Webster, Joan and Osborne, Sonya. 2015. "Incidence and predictors of lower limb split-skin graft failure and primary closure dehiscence in day-case surgical patients." Dermatologic Surgery. 41 (7), pp. 775-783. https://doi.org/10.1097/DSS.0000000000000391
The skin safety model: reconceptualizing skin vulnerability in older patients
Campbell, Jill L, Coyer, Fiona M. and Osborne, Sonya R.. 2016. "The skin safety model: reconceptualizing skin vulnerability in older patients." Journal of Nursing Scholarship. 48 (1), pp. 14-22. https://doi.org/10.1111/jnu.12176
Skin preparation of the patient – more than skin deep
Levada, Lilliana and Osborne, Sonya. 2017. "Skin preparation of the patient – more than skin deep." Journal of Perioperative Nursing. 30 (2), pp. 57-59.
Making evidence-based perioperative practices stick: an introduction to an implementation science approach
Osborne, Sonya. 2017. "Making evidence-based perioperative practices stick: an introduction to an implementation science approach." Journal of Perioperative Nursing. 30 (4), pp. 53-55.
New ACORN guideline: perioperative nursing management of posthumous organ procurement
Gore, Amanda and Osborne, Sonya. 2017. "New ACORN guideline: perioperative nursing management of posthumous organ procurement." Journal of Perioperative Nursing. 30 (1 - Autumn), pp. 56-59.
Nursing physical assessment for patient safety in general wards: reaching consensus on core skills
Douglas, Clint, Booker, Catriona, Fox, Robyn, Windsor, Carol, Osborne, Sonya and Gardner, Glenn. 2016. "Nursing physical assessment for patient safety in general wards: reaching consensus on core skills." Journal of Clinical Nursing. 25 (13-14), pp. 1890-1900. https://doi.org/10.1111/jocn.13201
Intrathecal morphine–related perioperative hypothermia in women undergoing cesarean delivery: a retrospective case-control study
Munday, Judy, Osborne, Sonya and Yates, Patsy. 2018. "Intrathecal morphine–related perioperative hypothermia in women undergoing cesarean delivery: a retrospective case-control study." Journal of PeriAnesthesia Nursing. 33 (1), pp. 3-12. https://doi.org/10.1016/j.jopan.2016.04.142
Preoperative warming versus no preoperative warming for maintenance of normothermia in women receiving intrathecal morphine for cesarean delivery: a single-blinded, randomized controlled trial
Munday, Judy, Osborne, Sonya, Yates, Patsy, Jones, Lee and Gosden, Edward. 2018. "Preoperative warming versus no preoperative warming for maintenance of normothermia in women receiving intrathecal morphine for cesarean delivery: a single-blinded, randomized controlled trial." Anesthesia and Analgesia. 126 (1), pp. 183-189. https://doi.org/10.1213/ANE.0000000000002026
Nursing service innovation: a case study examining emergency nurse practitioner service sustainability
Fox, Amanda, Gardner, Glenn and Osborne, Sonya. 2018. "Nursing service innovation: a case study examining emergency nurse practitioner service sustainability." Journal of Advanced Nursing. 74 (2), pp. 454-464. https://doi.org/10.1111/jan.13454
Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay
Osborne, Sonya, Harrison, Gai, O'Malia, Angela, Barnett, Adrian Gerard, Carter, Hannah E. and Graves, Nicholas. 2018. "Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay." BMJ Open. 8 (12), pp. 1-6. https://doi.org/10.1136/bmjopen-2018-023127
Does preoperative oral carbohydrate reduce hospital stay? A randomized trial
Webster, Joan, Osborne, Sonya Ranee, Gill, Richard, Chow, Carina Faran Kalan, Wallin, Siobhan, Jones, Lee and Tang, Annie. 2014. "Does preoperative oral carbohydrate reduce hospital stay? A randomized trial." AORN Journal. 99 (2), pp. 233-242. https://doi.org/10.1016/j.aorn.2013.12.003
Quantitative data collection and study validity
Osborne, Sonya and Schneider, Zevia. 2013. "Quantitative data collection and study validity." Schneider, Zevia, Whitehead, Dean, LoBiondo-Wood, Geri and Haber, Judith (ed.) Nursing and midwifery research: methods and appraisal for evidence-based practice. Australia. Elsevier - Mosby. pp. 200-217
Infection control
Osborne, Sonya. 2013. "Infection control." Crisp, Jackie, Potter, Patricia Ann, Taylor, Catherine, Rebeiro, Geraldine and Douglas, Clint (ed.) Potter and Perry's fundamentals of nursing. Chatswood, NSW, Australia. Elsevier - Mosby. pp. 703-752
The ACORN standards - our aide-memoire to professional practice
Osborne, Sonya. 2013. "The ACORN standards - our aide-memoire to professional practice." ACORN: the journal of perioperative nursing in Australia. 26 (4), pp. 14-15.
Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]
Webster, Joan, Osborne, Sonya, Rickard, Clare M. and New, Karen. 2013. "Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]." Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD007798.pub3
Nursing management: intraoperative care
Shoup, Anita, Reilly, Maureen, Kless, Jack and Osborne, Sonya. 2012. "Nursing management: intraoperative care." Brown, Diane and Edwards, Helen (ed.) Lewis's medical surgical nursing: assessment and management of clinical problems. Australia. Elsevier. pp. 402-420
Exploring the culture of non-reporting in the perioperative environment
Marshall, J. and Osborne, Sonya. 2007. "Exploring the culture of non-reporting in the perioperative environment." ACORN: the journal of perioperative nursing in Australia. 20 (2), pp. 10-21.
Imperatives and strategies for developing an evidence-based practice in perioperative nursing
Osborne, Sonya and Gardner, Glenn. 2004. "Imperatives and strategies for developing an evidence-based practice in perioperative nursing." ACORN: the journal of perioperative nursing in Australia. 17 (1), pp. 18-24.
Occupational exposures: balancing the costs of prevention vs treatment in operating theatres, with particular focus on double gloving practices
Osborne, Sonya. 2001. "Occupational exposures: balancing the costs of prevention vs treatment in operating theatres, with particular focus on double gloving practices." ACORN: the journal of perioperative nursing in Australia. 14 (2), pp. 16-21.
Care and preventative maintenance of surgical instrumentation: the scrub nurse's responsibility
Osborne, Sonya R.. 1999. "Care and preventative maintenance of surgical instrumentation: the scrub nurse's responsibility." ACORN: the journal of perioperative nursing in Australia. 12 (4), pp. 10-13.
Latex allergy: a perioperative environmental hazard
Osborne, Sonya R.. 1998. "Latex allergy: a perioperative environmental hazard." ACORN: the journal of perioperative nursing in Australia. 11 (4), pp. 26-28.