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The Journal of Hospital Infection Jun 2024Guidelines for pre-operative skin antisepsis recommend using chlorhexidine in an alcohol-based solution. However, other antiseptics such as aqueous povidone-iodine or... (Meta-Analysis)
Meta-Analysis Review
Guidelines for pre-operative skin antisepsis recommend using chlorhexidine in an alcohol-based solution. However, other antiseptics such as aqueous povidone-iodine or alcohol-based solutions continue to be used. Randomized controlled trials (RCTs) in caesarean section are rare and do not include all possible comparisons of antiseptics. The aim of this study was to assess the efficacy (reduction of surgical site infections) of chlorhexidine at two different concentrations (0.3% and 2%) and povidone-iodine in aqueous or alcohol-based solutions using a network meta-analysis, including only RCTs of caesarean sections. Fragility indices and prediction intervals were also estimated. A systematic literature review and network meta-analysis were performed. RCTs published up to February 2024 were collected from PubMed, ScienceDirect and the Cochrane Library. Interventions included alcohol-based povidone-iodine, aqueous povidone-iodine, and alcohol-based chlorhexidine 2% and 0.3%. The primary outcome measure was surgical site infection. Nine RCTs with 4915 patients and four interventions were included in the network meta-analysis. All credible intervals of the compared interventions overlapped. Alcohol-based 2% chlorhexidine had the highest probability of being effective in preventing surgical site infections, followed by alcohol-based povidone-iodine. The fragility index ranged from 4 to 18. The prediction intervals were wide. On the basis of rank probabilities, chlorhexidine 2% in an alcohol-based solution was most likely to be effective in preventing surgical site infections after caesarean section, followed by alcohol-based povidone-iodine. Given the paucity of literature and the relatively small difference between povidone-iodine and chlorhexidine found in our meta-analysis, we suggest that either can be used in an alcohol-based solution as antisepsis for planned or emergency caesarean section.
Topics: Humans; Cesarean Section; Anti-Infective Agents, Local; Randomized Controlled Trials as Topic; Surgical Wound Infection; Network Meta-Analysis; Chlorhexidine; Female; Povidone-Iodine; Pregnancy; Treatment Outcome
PubMed: 38688391
DOI: 10.1016/j.jhin.2024.03.021 -
Evidence-based Complementary and... 2020Sepsis is a global major health problem with high mortality rates. More effective therapy is needed for treating sepsis. Acupuncture has been used for various diseases,... (Review)
Review
BACKGROUND
Sepsis is a global major health problem with high mortality rates. More effective therapy is needed for treating sepsis. Acupuncture has been used for various diseases, including severe infection, in China for more than 2,000 years. Previous studies reported that acupuncture at Zusanli (ST36) might be effective in treating sepsis, but the efficacy and the quality of evidence remain unclear since there is no systematic review on acupuncture at ST36 for sepsis.
METHODS
Seven databases were searched from the inception of each database up to May 2019. Ultimately, 54 studies using acupuncture at ST36 for the treatment of experimental sepsis were identified in both English and Chinese literature with systematic review procedures.
RESULTS
Acupuncture might be useful in reducing injuries induced by sepsis in cardiac, lung, kidney, liver, gastrointestinal tract, and immune system. Its potential mechanisms for antisepsis might include reducing oxidative stress and inflammation, improving microcirculatory disturbance, and maintaining the immune balance mediated by dopamine. However, the positive findings should be interpreted with caution due to poor methodological quality and publication bias.
CONCLUSION
Acupuncture at ST36 might be a promising complementary strategy for controlling sepsis inflammation, yet further studies are needed.
PubMed: 32215037
DOI: 10.1155/2020/3620741 -
The Cochrane Database of Systematic... Jul 2006Arterial reconstructions with prosthetic graft materials or vein are susceptible to infection with a resultant high patient mortality and risk of limb loss. To reduce... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Arterial reconstructions with prosthetic graft materials or vein are susceptible to infection with a resultant high patient mortality and risk of limb loss. To reduce the risk of infection effective perioperative measures are essential.
OBJECTIVES
To determine the effectiveness of perioperative strategies to prevent infection in patients undergoing peripheral arterial reconstruction.
SEARCH STRATEGY
We searched the Cochrane Peripheral Vascular Diseases Group trials register (last searched May 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 2, 2006), and reference lists of relevant articles.
SELECTION CRITERIA
All randomised controlled trials (RCTs) evaluating measures intended to reduce or prevent infection in arterial surgery.
DATA COLLECTION AND ANALYSIS
AS and PSE independently selected and assessed the quality of included trials. Relative risk was used as a measure of effect for each dichotomous outcome.
MAIN RESULTS
Thirty-five RCTs were included. Of these, 23 were trials of prophylactic systemic antibiotics, three of rifampicin-bonded grafts, three of preoperative skin antisepsis, two of suction wound drainage, two of minimally invasive in situ bypass techniques, and individual trials of intraoperative glove change and wound closure techniques. Wound infection or early graft infection outcomes were recorded in all trials. Only two trials, both of rifampicin bonding, followed up graft infection outcomes to two years. Trials of antibiotics versus placebo were of highest quality with six double-blind studies of the ten included. Prophylactic systemic antibiotics reduced the risk of wound infection (Relative Risk (RR) 0.25, 95% Confidence Interval (CI) 0.17 to 0.38) and early graft infection in a fixed-effect model (RR 0.31, 95% CI 0.11 to 0.85, P = 0.02). Antibiotic prophylaxis for greater than 24 hours appears to be of no added benefit (RR 1.28, 95% CI 0.82 to 1.98). There was no evidence that prophylactic rifampicin bonding to dacron grafts reduced graft infection at either one month (RR 0.63, 95% CI 0.27 to 1.49) or two years (RR 1.05, 95% CI 0.46 to 2.40). There was no evidence of a beneficial or detrimental effect on rates of wound infection with suction groin-wound drainage (RR 0.96 95% CI 0.50 to 1.86) or of any benefit from a preoperative bathing or shower regimen with antiseptic agents over unmedicated bathing (RR 0.97, 95% CI 0.70 to 1.36).
AUTHORS' CONCLUSIONS
There is clear evidence of the benefits of prophylactic broad spectrum antibiotics. Many other interventions intended to reduce the risk of infection in arterial reconstruction lack evidence of effectiveness.
Topics: Antibiotic Prophylaxis; Arteries; Blood Vessel Prosthesis; Humans; Randomized Controlled Trials as Topic; Surgical Wound Infection
PubMed: 16855996
DOI: 10.1002/14651858.CD003073.pub2 -
Brazilian Journal of Anesthesiology... 2020The purpose of the Brazilian Society of Anesthesiology (SBA)’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current...
The purpose of the Brazilian Society of Anesthesiology (SBA)’s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
Topics: Anesthesia, Conduction; Brazil; Humans; Infections; Nerve Block; Practice Guidelines as Topic; Risk Factors
PubMed: 32636024
DOI: 10.1016/j.bjan.2020.02.005 -
Surgical Infections 2018Infections caused by continue to plague surgical patients, whether as surgical site infections or other nosocomial infections that complicate surgical care. The only...
Infections caused by continue to plague surgical patients, whether as surgical site infections or other nosocomial infections that complicate surgical care. The only meaningful methods available to decrease the risk of developing such infections are topical skin antisepsis (pre-operative skin preparation) and peri-operative antibiotic prophylaxis, neither of which offer a panacea. Alternatives to the latter are sought so as to minimize antibiotic selection pressure as a factor in the increasing problem of antimicrobial drug resistance. This review considers the possibility that immunization against may offer a viable alternative for prophylaxis. Review and synthesis of pertinent English-language medical literature. Vaccination against viral pathogens has been in successful clinical use for more than two centuries and was instrumental in the eradication of smallpox and the near-elimination of diseases such as poliomyelitis. Vaccinations against a limited number of bacterial pathogens (e.g., , , , type b, , ) have also been introduced with success, whereas others against bacteria are in development (, , ). Vaccination against infection is in current veterinary use (e.g., to prevent mastitis among dairy cattle) but has not been successful to date in human beings despite multiple attempts, although development continues. Because of its complex microbiology, including multiple virulence factors and the ability to evade host immune surveillance, presents numerous antigenic targets for vaccine development. Failure of two prior single-antigen vaccines in clinical trials has led to the consensus that future vaccine candidates must be directed against multiple antigens. Two distinct four-antigen vaccines are in clinical trials, but efficacy is yet to be determined.
Topics: Animals; Drug Development; Humans; Staphylococcal Infections; Staphylococcal Vaccines
PubMed: 31033407
DOI: 10.1089/sur.2018.263 -
Infection Control and Hospital... Jun 2012To evaluate the clinical effectiveness of preoperative skin antiseptic preparations and application techniques for the prevention of surgical site infections (SSIs). (Review)
Review
OBJECTIVE
To evaluate the clinical effectiveness of preoperative skin antiseptic preparations and application techniques for the prevention of surgical site infections (SSIs).
DESIGN
Systematic review of the literature using Medline, EMBASE, and other databases, for the period January 2001 to June 2011.
METHODS
Comparative studies (including randomized and nonrandomized trials) of preoperative skin antisepsis preparations and application techniques were included. Two researchers reviewed each study and extracted data using standardized tables developed before the study. Studies were reviewed for their methodological quality and clinical findings.
RESULTS
Twenty studies (n = 9,520 patients) were included in the review. The results indicated that presurgical antiseptic showering is effective for reducing skin flora and may reduce SSI rates. Given the heterogeneity of the studies and the results, conclusions about which antiseptic is more effective at reducing SSIs cannot be drawn.
CONCLUSIONS
The evidence suggests that preoperative antiseptic showers reduce bacterial colonization and may be effective at preventing SSIs. The antiseptic application method is inconsequential, and data are lacking to suggest which antiseptic solution is the most effective. Disinfectant products are often mixed with alcohol or water, which makes it difficult to form overall conclusions regarding an active ingredient. Large, well-conducted randomized controlled trials with consistent protocols comparing agents in the same bases are needed to provide unequivocal evidence on the effectiveness of one antiseptic preparation over another for the prevention of SSIs.
Topics: Administration, Cutaneous; Anti-Infective Agents, Local; Baths; Humans; Preoperative Care; Skin; Surgical Wound Infection
PubMed: 22561717
DOI: 10.1086/665723 -
Canadian Operating Room Nursing Journal Sep 2005Surgical face masks were originally developed to contain and filter droplets of microorganisms expelled from the mouth and nasopharynx of healthcare workers during... (Review)
Review
UNLABELLED
Surgical face masks were originally developed to contain and filter droplets of microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound. Surgical face masks have recently been advocated as a protective barrier between the surgical team and the patient, but the role of the surgical face mask as an effective measure in preventing surgical wound infections is questionable. The aim of the systematic review is to identify and review all randomised controlled trials evaluating disposable surgical face masks worn by the surgical team during clean surgery to prevent postoperative surgical wound infection. All relevant publications about disposable surgical face masks were sought through the Specialised Trials Register of the Cochrane Wounds Group (March 2001). Manufacturers and distributors of disposable surgical masks as well as professional organisations including the National Association of Theatre Nurses and the Association of Operating Room Nurses were contacted for details of unpublished and ongoing studies. Randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing the use of disposable surgical masks with the use of no mask were included.
MAIN RESULTS
Two randomised controlled trials were included involving a total of 1453 patients. In a small trial there was a trend towards masks being associated with fewer infections, whereas in a large trial there was no difference in infection rates between the masked and unmasked group. Neither trial accounted for cluster randomisation in the analysis.
REVIEWERS' CONCLUSIONS
From the limited results it is unclear whether wearing surgical face masks results in any harm or benefit to the patient undergoing clean surgery.
Topics: Antisepsis; Bias; Cost of Illness; Cross Infection; Data Interpretation, Statistical; Disposable Equipment; Equipment Failure; Humans; Infection Control; Masks; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic; Reproducibility of Results; Research Design; Research Support as Topic; Sample Size; Surgical Wound Infection
PubMed: 16295987
DOI: No ID Found -
Vaccine Oct 2019Rabies is a fatal zoonotic disease preventable through timely and adequate post-exposure prophylaxis (PEP) to potentially exposed persons i.e. wound washing and...
Rabies is a fatal zoonotic disease preventable through timely and adequate post-exposure prophylaxis (PEP) to potentially exposed persons i.e. wound washing and antisepsis, a series of intradermal (ID) or intramuscular (IM) rabies vaccinations, and rabies immunoglobulin in WHO category III exposures. The 2010 WHO position on rabies vaccines recommended PEP schedules requiring up to 5 clinic visits over the course of approximately one month. Abridged schedules with less doses have potential to save costs, increase patient compliance, and thereby improve equitable access to life-saving PEP for at-risk populations. We systematically reviewed new evidence since that considered for the 2010 position paper to evaluate (i) the immunogenicity and effectiveness of PEP schedules of reduced dose and duration; (ii) new evidence on effective PEP protocols for special populations; and (iii) the effect of changing routes of administration (ID or IM) during a single course of PEP. Our search identified a total of 14 relevant studies. The identified studies supported a reduction in dose or duration of rabies PEP schedules. The 1-week, 2-site ID PEP schedule was found to be most advantageous, as it was safe, immunogenic, supported by clinical outcome data and involved the least direct costs (i.e. cost of vaccine) compared to other schedules. To supplement this evidence, as yet unpublished additional data were reviewed to support the strength of the recommendations. Evidence suggests that changes in the rabies vaccine product and/or the route of administration during PEP is possible. Few studies have evaluated PEP schedules in persons with suspect or confirmed rabies exposures. Gaps exist in understanding the safety and immunogenicity of novel PEP schedules in special populations such as infants and immunocompromised individuals. Available data indicate that administering rabies vaccines during pregnancy is safe and effective.
Topics: Humans; Immunization Schedule; Immunoglobulins; Injections, Intradermal; Injections, Intramuscular; Post-Exposure Prophylaxis; Rabies; Rabies Vaccines; Treatment Outcome
PubMed: 30737043
DOI: 10.1016/j.vaccine.2019.01.041 -
Platelets Jan 2018The infection of a wound is one of the major contributors to delays in healing and tissue regeneration. As multi-drug resistance to antibiotics is becoming a serious... (Meta-Analysis)
Meta-Analysis Review
The infection of a wound is one of the major contributors to delays in healing and tissue regeneration. As multi-drug resistance to antibiotics is becoming a serious threat, research in this field has focused on finding new agents and strategies to fight infection and additionally to reduce healing times. The topical use of autologous Platelet Rich Plasma (PRP) as a biological accelerator of the healing process, has been safely used as a form of treatment for wounds since the 1990s. Although the presence or absence of leucocytes in PRP preparation was previously neglected, in the last decade more attention has been paid to their role and several studies have been conducted to explore both their immuno-metabolic effects and their antimicrobial properties. In this review, we aim to summarise the literature on the contribution of leucocytes included in PRP preparations in terms of their antimicrobial properties. This should help to inform clinical practice and additional research in this promising field.
Topics: Anti-Infective Agents; Antisepsis; Bacterial Infections; Biomarkers; Blood Platelets; Humans; Leukocytes; Platelet Activation; Platelet-Rich Plasma; Treatment Outcome
PubMed: 28681651
DOI: 10.1080/09537104.2017.1317731 -
BMC Pediatrics Jul 2022Surgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in...
BACKGROUND
Surgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in every surgical procedure. The most commonly used antiseptic agents for surgical skin preparation are chlorhexidine gluconate and iodophors in alcohol-based solutions. In adult patients the use of chlorhexidine-containing antiseptic solutions for preoperative skin preparation has been advocated to reduce SSI rates. Our objective was to conduct a systematic literature review on use of antiseptic agents for surgical skin preparation in children less than 16 years of age.
METHODS
A systematic review of MEDLINE, EMBASE, CINAHL and CENTRAL was performed using both MeSH and free text terms and using the relevant Cochrane filter to identify full text randomized trials (RCTs) and comparative observational studies. Interventions of interest were the choice of main agent in antiseptic solutions (chlorhexidine/povidone-iodine/alcohol) compared with each other or with other antiseptic agents. Primary outcome was the reported rate of surgical site infections.
RESULTS
In total 8 studies were included in the review; 2 RCTs and 6 observational studies. Observational studies generally did not primarily investigate the association of different antiseptics with subsequent SSI. The identified randomised controlled trials included only 61 children in total, and were of low quality. Consequently, we did not conduct a formal meta-analysis. Since the publication of a comprehensive systematic review of perioperative measures for the prevention of SSI in 2016, no randomized controlled trials comparing antiseptic agents for surgical skin preparation in paediatric surgery have been conducted.
CONCLUSION
Robust evidence on the optimal skin antisepsis to reduce SSIs in children is lacking. Direct extrapolation of effects from trials involving adults is not appropriate as physiologic characteristics and risk factors for SSIs differ between adults and children. It is therefore essential to conduct high quality RCT investigating interventions to identify optimal measures to reduce SSI rates in children.
TRIAL REGISTRATION
Prospero registration ( CRD42020166193 ).
Topics: Adult; Anti-Infective Agents, Local; Child; Chlorhexidine; Humans; Povidone-Iodine; Preoperative Care; Surgical Wound Infection
PubMed: 35902844
DOI: 10.1186/s12887-022-03502-z