Shi Lihua, Cai Li, Wan Fen, Jiang Yali, Choudhury Rupshikha, Rastogi Sanjay
Operating Room, Liyang People's Hospital, Changzhou, Jiangsu, China.
Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India.
Wideochir Inne Tech Maloinwazyjne. 2022 Jun;17(2):261-278. doi: 10.5114/wiitm.2021.112479. Epub 2022 Jan 9.
Surgical site infections (SSIs) occur after an operative procedure and can range from superficial to deep wound infections. The World Health Organization (WHO) and the Centers for Disease Control (CDC) have proposed guidelines recommending measures to prevent SSIs. Intraoperative measures are largely focused on decontamination of the skin and intraoperative wound irrigation using soap and antiseptics and are simple, efficient, and cost-effective measures to reduce SSIs. Povidone-iodine (PVI) is a topical antiseptic widely used for the reduction of SSIs.
A meta-analysis was conducted to determine the efficacy of preoperative or intraoperative use of PVI from randomized controlled trials (RCTs).
A systematic literature review was conducted using MEDLINE and Central databases for RCTs that involved PVI application versus saline or no treatment control groups across various surgical categories. The primary outcome was SSI or post-operative wound infections. A random-effects model was used to calculate the pooled risk ratio and subgroup analyses were performed.
A total of 59 RCTs were included in the meta-analysis with information from 20,497 patients. A reduction in overall SSI incidence was found (RR = 0.70, 0.60-0.80, p = 0.0002, I = 44%). Subgroup analyses showed that the comparator treatment and type of procedure did not modify the effect of PVI on SSI incidence. However, inconsistent results on SSI incidence were obtained when the data were stratified by PVI application method and surgery category.
The results of the meta-analysis provide support for the preoperative or intraoperative use of PVI in decreasing the incidence of SSI.
手术部位感染（SSIs）发生在手术操作之后，范围从浅表伤口感染到深部伤口感染。世界卫生组织（WHO）和疾病控制中心（CDC）已经提出了推荐预防手术部位感染措施的指南。术中措施主要集中在皮肤去污以及使用肥皂和消毒剂进行术中伤口冲洗，这些是降低手术部位感染的简单、有效且具有成本效益的措施。聚维酮碘（PVI）是一种广泛用于降低手术部位感染的局部消毒剂。
进行一项荟萃分析，以确定随机对照试验（RCTs）中术前或术中使用PVI的疗效。
使用MEDLINE和Central数据库对随机对照试验进行系统的文献综述，这些试验涉及在各种手术类别中PVI应用组与生理盐水或无治疗对照组的比较。主要结局是手术部位感染或术后伤口感染。采用随机效应模型计算合并风险比，并进行亚组分析。
荟萃分析共纳入59项随机对照试验，涉及20497名患者的信息。发现总体手术部位感染发生率有所降低（RR = 0.70，0.60 - 0.80，p = 0.0002，I² = 44%）。亚组分析表明，对照治疗和手术类型并未改变PVI对手术部位感染发生率的影响。然而，当按PVI应用方法和手术类别对数据进行分层时，在手术部位感染发生率方面获得了不一致的结果。
荟萃分析结果支持术前或术中使用PVI以降低手术部位感染的发生率。
