The Betadine trial - antiseptic wound irrigation prior to skin closure at caesarean section to prevent surgical site infection: A randomised controlled trial

Mahomed, Kassam; Ibiebele, Ibinabo; Buchanan, Julie

doi:10.1111/ajo.12437

Cited by 24 publications

(44 citation statements)

References 20 publications

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“…Furthermore, the evidence for the efficacy of PVI as an irrigant additive is inconclusive. A recently published study of more than 3,000 women undergoing cesarean delivery compared the use of no irrigation with PVI irrigation and found that PVI had no effect on the SSI rate …”

Section: A Bundle To Standardize the Incision Closure Processmentioning

confidence: 99%

“…A growing body of evidence supports the use of sterile aqueous 0.05% CHG solution for surgical irrigation . This solution is used just before closure of the incision to eliminate any contaminants that were introduced during the surgical procedure, and after waiting one minute for antimicrobial effect, is then rinsed out with sterile saline.…”

Section: A Bundle To Standardize the Incision Closure Processmentioning

confidence: 99%

“…A recently published study of more than 3,000 women undergoing cesarean delivery compared the use of no irrigation with PVI irrigation and found that PVI had no effect on the SSI rate. 62 A growing body of evidence supports the use of sterile aqueous 0.05% CHG solution for surgical irrigation. [61][62][63][64][65] This solution is used just before closure of the incision to eliminate any contaminants that were introduced during the surgical procedure, and after waiting one minute for antimicrobial effect, is then rinsed out with sterile saline.…”

Section: Irrigation With Aqueous 005% Chg Solutionmentioning

confidence: 99%

“…62 A growing body of evidence supports the use of sterile aqueous 0.05% CHG solution for surgical irrigation. [61][62][63][64][65] This solution is used just before closure of the incision to eliminate any contaminants that were introduced during the surgical procedure, and after waiting one minute for antimicrobial effect, is then rinsed out with sterile saline. Although higher concentrations of CHG are not approved for use on mucous membranes, the 0.05% concentration has been studied and determined to be safe and effective on mucous membranes.…”

Section: Irrigation With Aqueous 005% Chg Solutionmentioning

confidence: 99%

See 3 more Smart Citations

An Incision Closure Bundle for Colorectal Surgery

Edmiston¹,

Leaper²,

Barnes³

et al. 2018

AORN Journal

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Section: A Bundle To Standardize the Incision Closure Processmentioning

confidence: 99%

Section: A Bundle To Standardize the Incision Closure Processmentioning

confidence: 99%

Section: Irrigation With Aqueous 005% Chg Solutionmentioning

confidence: 99%

Section: Irrigation With Aqueous 005% Chg Solutionmentioning

confidence: 99%

See 2 more Smart Citations

An Incision Closure Bundle for Colorectal Surgery

Edmiston¹,

Leaper²,

Barnes³

et al. 2018

AORN Journal

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“…UK national data for 2017–2018 show a 28% caesarean section rate 1 and the Malaysian national caesarean delivery rate was 26% in 2015 2 . The surgical site infection (SSI) rate of a caesarean wound is about 9.8% 3 . SSI after caesarean delivery increases maternal morbidity, prolongs hospital stay and healthcare costs 4 …”

Section: Introductionmentioning

confidence: 99%

A randomised trial of caesarean wound coverage: exposed versus dressed

Tan

Rohani

Lim

et al. 2020

BJOG

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Objective To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure. Design Randomised trial. Setting University Hospital, Malaysia: April 2016–October 2016. Population 331 women delivered by caesarean section. Method Participants were randomised to leaving their wound entirely exposed (n = 165) or dressed (n = 166) with a low adhesive dressing (next day removal). Main outcome measures Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge. Results The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk [RR] 0.4, 95% CI 0.1–2.1; P = 0.45) and patient satisfaction with wound management was 7 [5–8] versus 7 [5–8] (P = 0.81) in exposed compared with dressed study groups, respectively. In the wound‐exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound‐dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre‐randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post‐hospital discharge self‐reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups. Conclusion The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken. Tweetable abstract An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance.

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Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Groenen,

Bontekoning,

Jalalzadeh

et al. 2024

JAMA Surg

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ImportanceSurgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.ObjectiveTo compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.Data SourcesPubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.Study SelectionIncluded in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.Data Extraction and SynthesisThis systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.Main Outcome and MeasureThe primary study outcome was SSI.ResultsA total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).Conclusions and RelevanceThis systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.

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The Betadine trial - antiseptic wound irrigation prior to skin closure at caesarean section to prevent surgical site infection: A randomised controlled trial

Abstract: PVI irrigation after the closure of fascia and before closure of skin is of no benefit in the prevention of SSI in women undergoing CS.

Cited by 24 publications

References 20 publications

An Incision Closure Bundle for Colorectal Surgery

An Incision Closure Bundle for Colorectal Surgery

A randomised trial of caesarean wound coverage: exposed versus dressed

Incisional Wound Irrigation for the Prevention of Surgical Site Infection

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