Lipp Allyson, Phillips Cheryl, Harris Paul, Dowie Iwan
Faculty of Health, Sport and Science, Department of Care Sciences, University of South Wales, Glyn Taff Campus, Pontypridd, Rhondda Cynon Taff, UK, CF37 1DL.
Cochrane Database Syst Rev. 2013 Aug 21(8):CD008062. doi: 10.1002/14651858.CD008062.pub3.
Surgical site infections (i.e. incisions that become infected) are a continuing concern in health care. Microbial sealant is a liquid that can be applied to the skin immediately before surgery and is thought to help reduce the incidence of surgical site infections (SSIs) by sealing in the skin flora, thus preventing contamination and infection of the surgical site.
To assess the effects of the preoperative application of microbial sealants (compared with no microbial sealant) on rates of SSI in people undergoing clean surgery.
For this first update we searched the following electronic databases in July 2013: the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE - In-Process & Other Non-Indexed Citations, Ovid EMBASE and EBSCO CINAHL.
Randomised controlled trials (RCTs) were eligible for inclusion if they involved people undergoing clean surgery (i.e. surgery that does not involve the breathing system, gut, genital or urinary tract or any part of the body with an existing infection) in an operating theatre and compared the use of preoperative microbial sealants with no microbial sealant.
All review authors independently extracted data on the characteristics, risk of bias and outcomes of the eligible trials.
Three trials (524 participants undergoing clean surgery) met the inclusion criteria. The trials all compared cyanoacrylate microbial sealant with no sealant, and, when pooled, we found there were fewer SSIs with the use of microbial sealant (10/261 participants) than with the control comparison (29/274 participants). The difference between the two groups was statistically significant (risk ratio (RR) 0.36, 95% CI 0.18 to 0.72) but given the number of participants and quality of the studies, they should be treated with caution. There were some adverse events in one study, but these were not judged to be a result of the use of microbial sealant.
AUTHORS' CONCLUSIONS: In this first update there is still insufficient evidence available to determine whether the use of microbial sealants reduces the risk of surgical site infection or not. Further rigorous, adequately-powered RCTs are required to investigate this properly.
手术部位感染（即手术切口发生感染）一直是医疗保健领域关注的问题。微生物密封剂是一种可在手术前立即涂抹于皮肤的液体，被认为通过封闭皮肤菌群来帮助降低手术部位感染（SSIs）的发生率，从而防止手术部位受到污染和感染。
评估术前应用微生物密封剂（与不使用微生物密封剂相比）对接受清洁手术患者手术部位感染发生率的影响。
在本次首次更新中，我们于2013年7月检索了以下电子数据库：Cochrane伤口组专业注册库、Cochrane对照试验中心注册库（CENTRAL）、Ovid MEDLINE、Ovid MEDLINE - 正在进行及其他非索引引用文献、Ovid EMBASE和EBSCO CINAHL。
如果随机对照试验（RCTs）涉及在手术室接受清洁手术（即不涉及呼吸系统、肠道、生殖或泌尿系统或任何存在现有感染的身体部位的手术）的患者，并比较了术前使用微生物密封剂与不使用微生物密封剂的情况，则符合纳入标准。
所有综述作者独立提取符合条件试验的特征、偏倚风险和结局数据。
三项试验（524名接受清洁手术的参与者）符合纳入标准。这些试验均比较了氰基丙烯酸酯类微生物密封剂与不使用密封剂的情况，汇总后我们发现使用微生物密封剂的手术部位感染患者（10/261名参与者）少于对照组（29/274名参与者）。两组之间的差异具有统计学意义（风险比（RR）0.36，95%可信区间0.18至0.72），但鉴于参与者数量和研究质量，应谨慎对待这些结果。一项研究中出现了一些不良事件，但这些事件未被判定为使用微生物密封剂的结果。
在本次首次更新中，仍没有足够的证据来确定使用微生物密封剂是否能降低手术部位感染的风险。需要进一步进行严格的、有足够样本量的随机对照试验来对此进行恰当研究。
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