Skin Preparation for the Prevention of Surgical Site Infection: A Scoping Review

Authors

DOI:

https://doi.org/10.15649/cuidarte.1054

Keywords:

Surgical Wound Infection, Anti-Infective Agents, Local, Hair Removal, Preoperative Period, Prevention & Control

Abstract

Introduction: Surgical Site Infections have an economic and social impact due to high costs during recovery, hospital stay and deterioration in quality of life. Therefore, it is required to identify interventions and recommendations for skin preparation aimed at preventing surgical site infection based on a scientific evidence-based approach. Materials and Methods: A systematic scoping review was conducted on English, Portuguese and Spanish articles published in Medline, Ovid, PubMed, Scielo, BVS, and Cochrane in 2010-2019 using the Joanna Briggs Institute approach and Prisma-P parameters. Results: After analyzing a total of 28 articles, 6 articles were found to be related to the general category (including guidelines for prevention of surgical site infection), 6 for preoperative bathing, 6 for preoperative hair removal and 10 for asepsis and antisepsis. Discussion: Although preoperative bathing is an internationally recognized practice, scientific evidence shows that this activity does not have any benefit. As for preoperative hair removal, it is not recommended except where absolutely necessary. As for surgical asepsis, mostly informative aspects are found about the use of antiseptics and chlorhexidine. Conclusions: Based on the systematic scoping review of the literature, a lack of standardization was found regarding interventions and recommendations for skin preparation for the prevention of Surgical Site Infection.

How to cite this article: Medina Garzón M, Castaño Plata María C, Moreno Herrera Cristhian C. Preparación de la piel para la prevención de la Infección del Sitio Operatorio: Revisión de Alcance. Revista Cuidarte. 2021;12(2):e1054. http://dx.doi.org/10.15649/cuidarte.1054     

Author Biographies

Mauricio Medina Garzón, Universidad Nacional de Colombia

Profesor, Universidad Nacional de Colombia - Sede Bogotá –Facultad de Enfermería- Bogotá- Colombia

María Camila Castaño Plata, Universidad Nacional de Colombia

Enfermera, Universidad Nacional de Colombia- Sede Bogotá- Facultad de Enfermería -Bogotá- Colombia

Cristhian Camilo Moreno Herrera, Universidad Nacional de Colombia

Enfermero, Universidad Nacional de Colombia - Sede Bogotá – Facultad de Enfermería-Bogotá- Colombia.

References

Keely Boyle K, Rachala S, Nodzo SR. Centers for Disease Control and Prevention 2017 Guidelines for Prevention of Surgical Site Infections: Review and Relevant Recommendations. Curr Rev Musculoskelet Med 2018;11(3):357–69. https://doi.org/10.1007/s12178-018-9498-8

Borges EL, Pires JF, Silva Abreu MN, de Araújo Lima VL, Silva PAB, Soares SM. Factors associated with the healing of complex surgical wounds in the breast and abdomen: Retrospective cohort study. Rev Lat Am Enfermagem. 2016; 24:55.

https://doi.org/10.1590/1518-8345.1398.2811

O’Hara LM, Thom KA, Preas MA. Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection (2017): A summary, review, and strategies for implementation. Am J Infect Control 2018;46(6):602–9.

https://doi.org/10.1016/j.ajic.2018.01.018

Harrington P. Prevention of surgical site infection. Nurs Stand. 2014;28(48):50–8. https://doi.org/10.7748/ns.28.48.50.e8958

Tsai DM, Caterson EJ. Current preventive measures for health-care associated surgical site infections: a review. Patient Saf Surg 2014;8(1):42. https://doi.org/10.1186/s13037-014-0042-5

Anchieta DW de, Matos FG de OA, Alves DCI, Santos RP dos, Oliveira JLC de, Dal Molin T. Caracterización de infecciones del sitio quirúrgico en un hospital público docente de la ciudad de Cascavel, Paraná. Visa em Debate. 2019;7(3):31-6. https://doi.org/10.22239/2317-269x.01277

Sociedad Española de Medicina Preventiva. Estudio Epine-Epps 2017 Según el protocolo "EPINE-Point prevalence survey of healthcare-associated infections and antimicrobial use in acute care hospitals Informe global de España. 2017.

Leaper DJ, Edmiston CE. World Health Organization: global guidelines for the prevention of surgical site infection. J Hosp Infect. 2017;95(2):135–6.

https://doi.org/10.1016/j.jhin.2016.12.016

Gould D. Causes, prevention and management of surgical site infection. Nurs Stand. 2012;26(47):47-56. https://doi.org/10.7748/ns2012.07.26.47.47.c9226

Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson KD, et al. A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates. Am J Infect Control 2014;42(8):820–8.

https://doi.org/10.1016/j.ajic.2014.07.002

Milena S, Vargas R, Torres G. Informe De Evento De Infecciones Asociadas a Dispositivos, Colombia, 2018. Pág. 2 de 17.

DeBaun B. Looking Forward—Infection Prevention in 2017. AORN J. 2016;104(6):531–5. Available from: http://dx.doi.org/10.1016/j.aorn.2016.09.016

Shi D, Yao Y, Yu W. Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysis, J. Clin. Nurs. 2017; 26:2907–14.

https://doi.org/10.1111/jocn.13661

Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141–6. https://doi.org/10.1097/XEB.0000000000000050

Hutton B, Catalá-López F, Moher D. La extensión de la declaración PRISMA para revisiones sistemáticas que incorporan metaanálisis en red: Prisma-Nma. Med Clin 2016;147(6):262–6. https://doi.org/10.1016/j.medcli.2016.02.025

Khalil H, Peters M, Godfrey CM, Mcinerney P, Soares CB, Parker D. An Evidence-Based Approach to Scoping Reviews. Worldviews on Evidence-Based Nurs. 2016;13(2):118–23. https://doi.org/10.1111/wvn.12144

Zeng X, Zhang Y, Kwong JSW, Zhang C, Li S, Sun F, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: A systematic review. Journal of Evidence-Based Medicine. 2015; 8:2–10. http://doi.wiley.com/10.1111/jebm.12141

Lenzen SA, Daniëls R, Van Bokhoven MA, Van Der Weijden T, Beurskens A. Disentangling self-management goal setting and action planning: A scoping review. Plos One. 2017;12(11): e0188822. https://doi.org/10.1371/journal.pone.0188822

Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. Amstar 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358:1-9. https://doi.org/10.1136/bmj.j4008.

De G, Clínica En P, Sns EL. Guía de Práctica Clínica para la Seguridad del Paciente Quirúrgico. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad 2010.

Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2015;35(6):605-627. https://dx.doi.org/10.1086%2F676022

The Canadian Patient Safety Insitute. Prevent Surgical Site Infections. Getting Started Kit. 2014. Available from: www.saferhealthcarenow.ca

National Services Scotland. Targeted literature review: What are the key infection prevention and control recommendations to inform a surgical site infection (SSI) prevention quality improvement tool? of existing infection prevention and control quality improvement tools to ensure ongoing need and fitness for purpose. 2012; Available from: https://www.documents.hps.scot.nhs.uk/hai/infection-control/evidence-for-care-bundles/literature-reviews/ssi-review.pdf.

Leaper DJ, Edmiston CE. World Health Organization: global guidelines for the prevention of surgical site infection. J Hosp Infect. 2017;95(2):135–6

https://doi.org/10.1016/j.jhin.2016.12.016.

Berriós-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. Vol. 152, JAMA Surg. American Medical Association; 2017;152(8):784–91. Available from: https://dx.doi.org/10.1001/jamasurg.2017.0904.

Gómez-Romero FJ, Fernández-Prada M, Navarro-Gracia JF. Prevention of Surgical Site Infection: Analysis and Narrative Review of Clinical Practice Guidelines. Cir Esp. 2017;95(9):490–502.https://doi.org/10.1016/j.ciresp.2017.09.004

Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev.2015;(2).

https://doi.org/10.1002/14651858.CD004985.pub5.

Franco LM de C, Cota GF, Pinto TS, Ercole FF. Preoperative bathing of the surgical site with chlorhexidine for infection prevention: Systematic review with meta-analysis. Am J Infect Control. 2017 ;45(4):343–9. Available from: https://doi.org/10.1016/j.ajic.2016.12.003.

Chlebicki MP, Safdar N, O’Horo JC, Maki DG. Preoperative chlorhexidine shower or bath for prevention of surgical site infection: A meta-analysis. Vol. 41, Am. J. Infect. Control. 2013. p. 167–73. Available from: http://dx.doi.org/10.1016/j.ajic.2012.02.014.

Zywiel MG, Daley JA, Delanois RE, Naziri Q, Johnson AJ, Mont MA. Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty. Int Orthop. 2011 ;35(7):1001–6. https://doi.org/10.1007/s00264-010-1078-5

Alawadi ZM, Kao LS. Chlorhexidine Gluconate, 4%, Showers and Surgical Site Infection Reduction. Jama Surg. 2015;150(11):1033. https://doi.org/10.1001/jamasurg.2015.2219

Sebastian S. Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review. J Neurosci Nurs.2012 V;44(3):149–156. https://doi.org/10.1097/JNN.0b013e31825106d2.

Lefebvre A, Saliou P, Lucet JC, Mimoz O, Keita-Perse O, Grandbastien B, et al. Preoperative hair removal and surgical site infections: network meta-analysis of randomized controlled trials. J Hosp Infect. 2015;91(2):100–8. https://doi.org/10.1016/j.jhin.2015.06.020.

Kowalski TJ, Kothari SN, Mathiason MA, Borgert AJ. Impact of Hair Removal on Surgical Site Infection Rates: A Prospective Randomized Noninferiority Trial. In: Journal of the American College of Surgeons; 2016. P:704–11.

http://dx.doi.org/10.1016/j.jamcollsurg.2016.03.032

Shi D, Yao Y, Yu W. Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysis. J Clin Nurs. 2017;26(19–20):2907–14.

https://doi.org/10.1111/jocn.13661

Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011;(11):CD004122.

https://dx.doi.org/10.1001/jamasurg.2017.0904

Maya JJ, Ruiz SJ, Pacheco R, Valderrama SL, Villegas MV. Papel de la clorhexidina en la prevención de las infecciones asociadas a la atención en salud. Rev. Infectio. 2011;15(2):98–107. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0123-93922011000200004&lng=en

Zinn J, Jenkins JB, Harrelson B, Wrenn C, Haynes E, Small N. Differences in intraoperative prep solutions: a retrospective chart review. AORN Journal. 2013;97(5):552–8.

https://doi.org/10.1016/j.aorn.2013.03.006

Charles D, Heal CF, Delpachitra M, Wohlfahrt M, Kimber D, Sullivan J, et al. Alcoholic versus aqueous chlorhexidine for skin antisepsis: The Avalanche Trial. Rev. CMAJ. 2017 8;189(31): E1008–16. https://doi.org/10.1503/cmaj.161460.

Wang Z, Zheng J, Zhao Y, Xiang Y, Chen X, Zhao F, et al. Preoperative bathing with chlorhexidine reduces the incidence of surgical site infections after total knee arthroplasty: A meta-analysis. Medicine (Baltimore). 2017;96(47): e8321.

https://doi.org/10.1097/MD.0000000000008321

Makhni MC, Jegede K, Lombardi J, Whittier S, Gorroochurn P, Lehman RA, et al. No Clear Benefit of Chlorhexidine Use at Home Before Surgical Preparation. J Am Acad Orthop Surg. 2018;26(2): e39–e47. https://doi.org/10.5435/jaaos-d-16-00866

John B, K. K. Rajith K, C. Vipinchandran. Comparison of efficacy of chlorhexidine alcohol with povidone iodine for prevention of surgical site infection: a prospective study. Int Surg J. 2018; 1668:72. https://dx.doi.org/10.18203/2349-2902.isj20181480

Darouiche RO, Wall MJ, Itani KMF, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. The new england journal of medicine. 2010;18-26.

Available from: www.nejm.org https://doi.org/10.1056/NEJMoa0810988

Harnoss JC, Assadian O, Kramer A, Probst P, Müller-Lantzsch C, Scheerer L, et al. Comparison of chlorhexidine-isopropanol with isopropanol skin antisepsis for prevention of surgical-site infection after abdominal surgery. Br J Surg. 2018;105(7):893–9. https://doi.org/10.1002/bjs.10793.

Patrick S, McDowell A, Lee A, Frau A, Martin U, Gardner E, et al. Antisepsis of the skin before spinal surgery with povidone iodine-alcohol followed by chlorhexidine gluconate-alcohol versus povidone iodine-alcohol applied twice for the prevention of contamination of the wound by bacteria: a randomised controlled trial. The Bone Joint J. 2017;99-B (10):1354–65. https://doi.org/10.1302/0301-620X.99B10.BJJ-2017-0291.R1

Edmiston CE, Lee CJ, Krepel CJ, et al. Evidence for a standardized preadmission showering regimen to achieve maximal antisepti. Jama Surg. 2015;150(11):1027-33. https://doi.org/10.1001/jamasurg.2015.2210

Published

2021-04-27

How to Cite

1.
Medina Garzón M, Castaño Plata MC, Moreno Herrera CC. Skin Preparation for the Prevention of Surgical Site Infection: A Scoping Review. Revista Cuidarte [Internet]. 2021 Apr. 27 [cited 2024 Nov. 22];12(2). Available from: https://revistas.udes.edu.co/cuidarte/article/view/1054

Altmetrics

Downloads

Download data is not yet available.