Webster J, Osborne S
Royal Brisbane and Royal Women's Hospital and Health Service Districts, Centre for Clinical Nursing, Building 34, Butterfield Street, Herston, QLD, Australia, 4029.
Cochrane Database Syst Rev. 2006 Apr 19(2):CD004985. doi: 10.1002/14651858.CD004985.pub2.
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.
To review the evidence for preoperative bathing or showering with antiseptics for the prevention of hospital-acquired (nosocomial) surgical site infection.
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.
Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in patients undergoing surgery.
Two authors independently assessed studies for selection, trial quality and extracted data. Study authors were contacted for additional information.
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.
手术部位感染（SSIs）是侵入性（手术）操作后发生的伤口感染。术前使用抗菌皮肤清洗产品进行沐浴或淋浴是一种广泛认可的减少皮肤细菌（微生物群）的方法。减少皮肤微生物群是否会降低手术部位感染的发生率尚不清楚。
综述术前使用抗菌剂进行沐浴或淋浴以预防医院获得性（医院内）手术部位感染的证据。
我们检索了Cochrane伤口小组专业注册库（2005年12月）、Cochrane对照试验中心注册库（Cochrane图书馆2005年第4期）、MEDLINE（1966年1月至2005年12月）以及文章的参考文献列表。
比较用于术前全身沐浴或淋浴的任何抗菌制剂与非抗菌制剂在接受手术患者中的随机对照试验。
两位作者独立评估研究的入选情况、试验质量并提取数据。联系研究作者获取更多信息。
纳入了6项试验，共涉及10007名参与者。其中3项纳入试验有3个比较组。所有试验中使用的抗菌剂均为4%葡萄糖酸氯己定（洗必泰）。3项涉及7691名参与者的试验将氯己定与安慰剂进行了比较。与安慰剂相比，用氯己定沐浴并未使手术部位感染在统计学上显著降低；手术部位感染的相对风险（RR）为0.91（95%置信区间（CI）0.80至1.04）。当此比较仅纳入高质量试验时，手术部位感染的RR为0.95（95%CI 0.82至0.10）。3项涉及1443名参与者的试验将肥皂与氯己定进行了比较；合并后手术部位感染风险无差异（RR 1.02，95%CI 0.57至1.84）。2项涉及1092名患者的试验将用氯己定沐浴与不沐浴进行了比较用氯己定清洗的患者与术前未清洗的患者术后手术部位感染率无差异（RR 0.70，95%CI 0.19至2.58）。
本综述提供的证据表明，与其他清洗产品相比，术前用氯己定淋浴或沐浴对减少手术部位感染无益处。降低医院内手术部位感染发生率的努力应集中在已证明有效果的干预措施上。
