Randomized Controlled Trial of the Effectiveness of Chlorhexidine Showers Before Elective Plastic Surgical Procedures

Veiga, Daniela Francescato; Damasceno, Carlos Américo Veiga; Veiga-Filho, Joel; Figueiras, Ricardo Góes; Vieira, Roberto Bezerra; Garcia, Edgard S.; Silva, Virgínia Vilasboas; Novo, Neil Ferreira; Ferreira, Lydia Masako

doi:10.1086/592980

Cited by 65 publications

(44 citation statements)

References 10 publications

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“…The chlorhexidine protocol required one application the evening before and another one the morning of surgery, similar to that of patients in this study. No patients in either the control or experimental group developed infections (zero of 50 for both groups); however, cultures revealed that there was a threefold decrease in the colony count for patients who received chlorhexidine, which has been demonstrated in additional studies [2,19,28]. Although the results of our study are supportive of the use of chlorhexidine cloths for preoperative sterilization, other studies have reported findings in opposition to ours.…”

Section: Discussionsupporting

confidence: 46%

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Knee Arthroplasty?

Kapadia

Zhou

Jauregui

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Many preventive methodologies seek to reduce the risk of surgical site infections after total knee arthroplasty (TKA), including the use of preoperative chlorhexidine baths and cloths. Although we have demonstrated in previous studies that this may be an efficacious method for infection prevention, our study was underpowered and we therefore set out to evaluate this with a larger sample size. Questions/purposes (1) Does a preadmission chlorhexidine cloth skin preparation protocol decrease the risk of surgical site infection in patients undergoing TKA? (2) When stratified using the National Healthcare Safety Network (NHSN) risk categories, which categories are associated with risk reduction from the preadmission chlorhexidine preparation protocol? Methods In our study, all patients (3717 total) who had undergone primary or revision TKA at a single institution between January 1, 2007, and December 31, 2013, were identified, of whom 991 patients used the chlorhexidine cloths before surgery and 2726 patients did not. All patients were provided cloths with instructions before surgery; however, as a result of a lack of compliance, we were able to substratify patients into treatment and control cohorts. Additionally, we substratified patients by NHSN risk category to determine differences in infection between the two cohorts (cloth versus no cloth). Patient medical records and an infection-tracking database were reviewed to determine the development of periprosthetic infection (patients who had superficial infections were excluded from our study) in both groups after 1 year surveillance. We then calculated relative risk reductions with use of chlorhexidine gluconate and stratified results based on NHSN risk category. RR, 8.3 [CI,; p = 0.038), but no significant difference was detected in the low-and medium-risk groups (RR, 2.1 [CI, 0.5-9.6; p = 0.33] and RR, 11.3 [CI,; p = 0.09]).

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Section: Discussionsupporting

confidence: 46%

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Knee Arthroplasty?

Kapadia

Zhou

Jauregui

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Usually the skin preparation is performed with a preoperative shower, then a scrub with bactericidal soap in the operating room, followed by application of a long-acting bactericidal agent. A systematic review has shown that no reduction in surgical site infection was found for preoperative bathing with chlorhexidine soap compared with bar soap or placebo [46]. Some surgeons apply only the long-acting bactericidal agent without the preoperative applications of soap and seem to be equal effective compared with the traditional method.…”

Section: Resultsmentioning

confidence: 99%

Technical aspects of the cesarean section

et al. 2010

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The aim of this study was to evaluate every part of the surgical procedure during cesarean section (CS) to prevent complications and improve the clinical outcome. We researched on PubMed, Medline, and Cochrane. The evidence-based research suggests a transverse incision of the skin, blunt dissection of the subcutaneous tissue, omission of the bladder flap, blunt extension of the hysterotomy, prophylactic antibiotics, spontaneous placental removal, leaving the peritoneum open, and suture closure of the subcutaneous tissue when thickness is ≥2 cm. We hope that all evidence-based description will help to perform the CS safer, and for all surgical procedures not yet studied, further research is needed.

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“…Veiga et al 17 em um ensaio clínico que também ava- Diante da falta de evidências em relação ao banho pré--operatório com clorexidina 4%, é necessária cautela ao recomendar essa prática como uma estratégia para reduzir ISC.…”

Section: Discussionunclassified

“…Outras discussões também são levantadas nesta temática, como o número de banhos, o momento ideal para o banho, a técnica que deve ser realizada, se o corpo inteiro deve ser lavado com o antisséptico ou somente o local a ser operado e se a solução antisséptica deve ser retirada ou não da pele por meio do enxague. 16,17 Revisão sistemática envolvendo 10. 157 pacientes que realizaram diferentes tipos de cirurgias, com classificação do potencial de contaminação distintos não observou evidência sobre a eficácia do banho com clorexidina 4% na redução da ISC.…”

Section: Introductionunclassified

Effects of Pre-Operative Bath in the Prevention of Surgical Infection: Pilot Clinical Study

Franco¹,

Almeida²,

Duarte³

et al. 2017

REME: Revista Mineira De Enfermagem

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RESUMOAs infecções articulares periprotéticas ocorridas nas artroplastias do quadril são um grande desafio para o paciente, equipe e instituições de saúde. Estudo do tipo ensaio clínico piloto, randomizado, controlado e cego para avaliar o efeito do banho pré-operatório utilizando as soluções gluconato de clorexidina 4%, polivinilpirolidona iodo (PVP-I) 10% degermante ou sabão sem antisséptico na prevenção de infecção de sítio cirúrgico (ISC), em pacientes submetidos à cirurgia de artroplastia do quadril. A amostra foi composta por 45 pacientes adultos submetidos à cirurgia eletiva de artroplastia total do quadril, que não tinham relato de infecção no local cirúrgico e alergia às soluções utilizadas e que não eram portadores nasais de Staphylococcus aureus. Os grupos de pacientes randomizados apresentaram homogeneidade em relação às características epidemiológicas e clínicas. A taxa de ISC entre os grupos foi de 20% para clorexidina, 6,7 para o PVP-I e sabão sem antisséptico, respectivamente. Não foram encontradas diferenças estatísticas entre os três grupos de intervenção. É necessária cautela ao recomendar o banho pré-operatório com clorexidina como estratégia para reduzir infecção de sítio cirúrgico. Clinical Trials nº NCTO3001102. Palavras-chave: Banhos; Enfermagem Perioperatória; Infecção da Ferida Cirúrgica; Artroplastia de Quadril; Anti-Infecciosos Locais. ABSTR ACT Periprosthetic joint infections in hip arthroplasties are a major challenge for the patient, staff, and health institutions. A randomized, controlled, blinded pilot clinical trial to evaluate the effect of the preoperative bath using 4% chlorhexidine gluconate solutions, polyvinylpyrrolidone iodine (PVP-I)10% degermant or non-antiseptic soap in the prevention of surgical site infection (SSI), in patients undergoing

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Randomized Controlled Trial of the Effectiveness of Chlorhexidine Showers Before Elective Plastic Surgical Procedures

Cited by 65 publications

References 10 publications

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Knee Arthroplasty?

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Knee Arthroplasty?

Technical aspects of the cesarean section

Effects of Pre-Operative Bath in the Prevention of Surgical Infection: Pilot Clinical Study

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