Preoperative skin antiseptics for preventing surgical wound infections after clean surgery

Dumville, Jo C; McFarlane, Emma; Edwards, Peggy; Lipp, Allyson; Holmes, Amy

doi:10.1002/14651858.cd003949.pub3

Cited by 212 publications

(97 citation statements)

References 35 publications

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“…Pre-operative skin antiseptics for preventing surgical wound infections after clean surgery 246 To determine whether or not pre-operative skin antisepsis immediately prior to surgical incision for clean surgery prevents surgical site infection and to determine the comparative effectiveness of alternative antiseptics Update DOI: 10.3310/pgfar04130 PROGRAMME GRANTS FOR APPLIED RESEARCH 2016 VOL. 4 NO.…”

Section: Surgical Wounds Reviewmentioning

confidence: 99%

“…245 A review evaluating pre-operative skin antiseptics for preventing surgical wound infection after clean surgery found that 0.5% chlorhexidine may be more effective than alcohol-based povidone iodine paint. 246 Most findings should be viewed with caution because of the poor quality of much of the evidence base. This particularly related to risk of bias and imprecision.…”

Section: Evidence Synthesis For Clinical Decision-making (Worktream 3)mentioning

confidence: 99%

“…As a result of this, several topics were pinpointed as suitable candidates for Cochrane reviews, either as new reviews or updates of existing reviews. Eleven reviews were undertaken overall on interventions for diabetic foot ulcers (five reviews [192][193][194][195]244 ), venous leg ulcers (five reviews 184,[197][198][199]245 ) and surgical wounds (one review 246 ). All used standard Cochrane systematic review methodology as described in the Cochrane Handbook for Systematic Reviews of Interventions 163 and all were carried out under the auspices of the Cochrane Wounds Group (see http://wounds.cochrane.org/).…”

Section: Introductionmentioning

confidence: 99%

“…245 Review of interventions used with surgical wounds l Pre-operative skin antiseptics for preventing surgical wound infections after clean surgery. 246 …”

Section: Introductionmentioning

confidence: 99%

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Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Surgical Wounds Reviewmentioning

confidence: 99%

Section: Evidence Synthesis For Clinical Decision-making (Worktream 3)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…245 Review of interventions used with surgical wounds l Pre-operative skin antiseptics for preventing surgical wound infections after clean surgery. 246 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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“…Use of chlorhexidinealcohol as an antiseptic reduces surgical site infections compared with povidone-iodine in clean surgery. 36,38,39 This effect is thought to be related to a faster and more persistent activity despite exposure to bodily fluids during surgery. Use of transparent films, diathermia or substances to prevent bleeding have not proven beneficial.…”

Section: Peri-operativementioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

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