Sapijaszko Mariusz, Samadi Sana, Chow Eunice Y
Division of Dermatology, Department of Medicine, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C. MacKenzie Health Sciences Centre, Edmonton, AB, Canada.
J Cutan Med Surg. 2025 Mar-Apr;29(2):167-178. doi: 10.1177/12034754241303086. Epub 2024 Dec 3.
We aim to review modifiable risk factors and practices for surgical site infections (SSIs) reduction in cutaneous surgeries. The existing norms are assessed with the latest evidence, with the aim of enhancing and optimizing intra and postoperative strategies. This review seeks to offer an updated summary of the results of evidence for SSI reduction strategies tailored for practicing general dermatologists. Searches were conducted for using PubMed Central and DynaMed. Articles with pragmatic guideline recommendations were selected. We found evidence for intraoperative factors such as non-sterile gloves, brushless hand scrubbing/simple hand washing, sterile materials, and chlorhexidine gluconate as a skin antiseptic. For postoperative factors, there is a lack of evidence to support the use of topical antibiotic ointments, dressings, or waiting 48 hours before wetting to prevent SSI. Several intra/postoperative factors not specific to dermatologic procedures are briefly discussed for additional context. Several SSI risk factors are inherent to patients or necessary procedures; however, dermatologists have identified modifiable risk factors and developed protocols to mitigate SSI risks intraoperatively and postoperatively. By questioning established practices in cutaneous surgery aimed at preventing SSIs, we can work towards the optimal utilization of resources. This dual-focused approach not only enhances the efficiency of the healthcare system but also diminishes the risks associated with SSIs. It is important to acknowledge that this review does not encompass all factors essential for consideration in these recommendations. Nonetheless, it will approach these factors with an evidence-based lens, placing SSI prevention at the forefront.
我们旨在回顾可改变的风险因素及相关做法，以减少皮肤外科手术部位感染（SSIs）。依据最新证据对现有规范进行评估，目的是加强和优化术中及术后策略。本综述旨在为执业普通皮肤科医生提供关于减少SSIs策略的证据结果的最新总结。通过PubMed Central和DynaMed进行检索。选取了具有实用指南建议的文章。我们发现了术中因素的相关证据，如非无菌手套、免刷手消毒/简单洗手、无菌材料以及葡萄糖酸氯己定作为皮肤消毒剂。对于术后因素，缺乏证据支持使用外用抗生素软膏、敷料或在湿润前等待48小时以预防SSIs。为提供更多背景信息，简要讨论了一些并非皮肤外科手术特有的术中/术后因素。一些SSIs风险因素是患者自身固有的或手术必要过程中存在的；然而，皮肤科医生已识别出可改变的风险因素，并制定了方案以在术中及术后降低SSIs风险。通过质疑皮肤外科手术中旨在预防SSIs的既定做法，我们可以朝着资源的最佳利用努力。这种双重点方法不仅提高了医疗系统的效率，还降低了与SSIs相关的风险。必须承认，本综述并未涵盖这些建议中所有需要考虑的因素。尽管如此，它将以循证的视角探讨这些因素，把预防SSIs置于首位。
