Webster Joan, Osborne Sonya
Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Brisbane, Australia.
Cochrane Database Syst Rev. 2012 Sep 12(9):CD004985. doi: 10.1002/14651858.CD004985.pub4.
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 preventing hospital-acquired (nosocomial) surgical site infections.
For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 29 June 2012); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012 Issue 6); Ovid MEDLINE (2010 to June Week 3 2012), Ovid MEDLINE (In-Process & Other Non-Indexed Citations June 27, 2012); Ovid EMBASE (2010 to 2012 Week 25), EBSCO CINAHL (1882 to 21 June 2012) 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 people undergoing surgery.
Two review authors independently assessed studies for selection, risk of bias and extracted data. Study authors were contacted for additional information.
We did not identify any new trials for inclusion in this fourth 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.
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公认的减少皮肤细菌（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预防医院获得性（医院内）手术部位感染的证据。
在本次第四次更新中，我们检索了Cochrane伤口小组专业注册库（检索时间为2012年6月29日）；Cochrane对照试验中心注册库（《Cochrane图书馆》2012年第6期）；Ovid MEDLINE（2010年至2012年第3周）、Ovid MEDLINE（在研及其他非索引引文，2012年6月27日）；Ovid EMBASE（2010年至2012年第25周）、EBSCO CINAHL（1882年至2012年6月21日）以及文章的参考文献列表。
比较任何用于术前全身沐浴或淋浴的抗菌制剂与非抗菌制剂在手术患者中的随机对照试验。
两位综述作者独立评估研究以进行选择、偏倚风险评估并提取数据。与研究作者联系以获取更多信息。
在本次第四次更新中，我们未发现任何新的纳入试验。纳入了7项试验，共涉及10157名参与者。其中4项纳入试验有3个比较组。所有试验中使用的抗菌剂为4%葡萄糖酸氯己定（洗必泰/利奥洗必泰）。3项涉及7791名参与者的试验比较了氯己定与安慰剂。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）。当该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1.10）。3项涉及1443名参与者的试验比较了肥皂与氯己定；合并后手术部位感染风险无差异（RR 1.02，95%CI 0.57至I.84）。3项涉及1192名患者的试验比较了用氯己定沐浴与不沐浴的情况，一项大型研究发现用氯己定沐浴有统计学显著差异，支持用氯己定沐浴（RR 0.36，95%CI 0.17至0.79）。较小的研究发现术前用氯己定清洗的患者与未清洗的患者之间无差异。
本综述未提供明确证据表明术前用氯己定沐浴或淋浴相较于其他清洗产品在减少手术部位感染方面更有益。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。
