Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections

Abstract

Low-quality evidence suggests considering the use of prophylactic incisional wound irrigation to prevent SSI with an aqueous povidone-iodine solution. Antibiotic irrigation does not show a benefit and therefore is discouraged.

Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

“…In the same meta-analysis, a low quality of evidence demonstrated a statistically significant benefit for incisional wound irrigation with an aqueous povidone iodine solution in clean and clean-contaminated wounds (OR 0.31; 95% CI 0.13-0.73; P = 0.007); 50 fewer SSI per 1000 procedures (from 19 fewer to 64 fewer) [51].…”

“…Twenty-one RCTs were identified comparing wound irrigation with no wound irrigation in patients undergoing various surgical procedures, and the results were substantially heterogeneous [51] Saline irrigation was not effective in reducing SSIs [52]. However, when the saline was applied with a syringe to generate some pressure [53], a reduction in the risk of SSI compared with no irrigation was shown in one study (OR 0.35; 95% CI 0.19-0.65; P = 0.0009).…”

Local Vancomycin Effectively Reduces Surgical Site Infection at Implant Site in Rodents

“…The newest World Health Organization recommendations on preventing SSI state that "antibiotic surgical wound irrigation before closure should not be used for the purpose of preventing SSI" because of the "unnecessary risk of antimicrobial resistance" 1 and that "antibiotic irrigation had no significant effect in reducing SSIs." 15 The newest Centers for Disease Control and Prevention recommendations on preventing SSI also do not recommend "antimicrobial irrigation." 16 However, implantable devices represent a special problem because these implants can develop biofilms when infected that are "notoriously recalcitrant to antimicrobial therapy" once they have invaded the device.…”

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

“…During the last decade of the twentieth century (and in some more recent literature [25][26][27][28][29][30][31][32]) animal and other experimental studies began addressing the question of which fluid and how much [8,[25][26][27][33][34][35][36][37][38][39][40]. It was during this period that the potential adverse effects of the use of abdominal washouts were described: upregulation of pro-inflammatory mediators, damage to peritoneal mesothelial cells and polymorphonuclear neutrophil membranes, promotion of postoperative adhesions, documented instances of bacterial translocation, failure to effectively decrease peritoneal bacterial counts, and potential adverse effects on final hemostasis (through technical or chemical issues) [7,33].…”

“…A few systematic reviews have recently tried to provide some answers to this issue; but the evidence-base used has clear problems, i.e. the studies pooled are greater than 14 years old in more than 60% of the cases (in fact only 4 studies were more recent than the year 2010, only 2 of which are focused on the peritoneal cavity) [28][29][30][31]. Our interpretation of these meta-analyses and systematic reviews is in line with the conclusions reached by our own study; in that there is no benefit to large volume intra-peritoneal lavage with normal saline and, in fact, larger volumes can potentially increase complications rates.…”