-
JBI Database of Systematic Reviews and... May 2015Gloves are worn to protect hands from contamination from microorganisms and to reduce the risks of transmission of microorganisms from healthcare workers to patients and... (Review)
Review
BACKGROUND
Gloves are worn to protect hands from contamination from microorganisms and to reduce the risks of transmission of microorganisms from healthcare workers to patients and vice versa. However, gloves should be changed between patient contacts and hand washing is necessary before putting on gloves and immediately after removing gloves.
OBJECTIVE
The objective of this review was to evaluate and synthesize the best available research evidence that investigates clinical use of gloves in the prevention of cross transmission.
TYPES OF PARTICIPANTS
Health care workers.Types of intervention(s): Glove use intervention. Types of outcomes: Contamination of healthcare workers' hands, transmission of infections, adherence to glove usage, inappropriate uses of gloves, and adherence to hand hygiene. Types of studies: Quasi-experimental studies and descriptive studies.
SEARCH STRATEGY
The search sought to find published and unpublished studies. The time period of the search covered articles published from 2000 to 2012 in English and Thai. The databases searched included: MEDLINE, CINAHL, EMBASE, The Cochrane Library, PubMed, Science Direct, Current Content Connect, Blackwell synergy, Thai Nursing Research Database, Thai thesis database, Digital Library of Thailand Research Fund, Research of National Research Council of Thailand, and Database of Office of Higher Education.
METHODOLOGICAL QUALITY
Studies selected for retrieval were assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument software.
DATA COLLECTION
Data extraction was performed using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument software.
DATA SYNTHESIS
A meta-synthesis was not possible due to the methodological heterogeneity of the included papers. The evidence was thus presented as a narrative summary.
RESULTS
Twenty-three studies were included in this review. The results indicated that contamination of a healthcare worker's gloves with bacteria during routine care activities is common. The use of gloves can protect the hands of healthcare workers from bacterial contamination, but the protection afforded by the gloves was incomplete. Adherence to glove utilization among healthcare workers was suboptimal. Gloves were overused and often misused. The major break in compliance with glove use was failure to change gloves between procedures on the same patient. Inappropriate glove use can increase the risk of cross transmission. It is unclear if modifications in glove use alter compliance with hand hygiene among healthcare workers.
CONCLUSION
Gloving can reduce acquisition of microorganisms on the hands. However, gloving does not completely prevent contamination of the hands. Compliance with glove use among healthcare workers is poor. Gloves were also overused and often misused. Inappropriate glove use can increase the risk of cross transmission via contaminated gloved hands. There is still not enough evidence to prove the influence of glove use on adherence to hand hygiene.
IMPLICATIONS FOR PRACTICE
This review strengthens the recent suggestion on the use of gloves to reduce bacterial contamination. However, gloving does not completely prevent contamination, thus emphasizing the need for hand antisepsis before and after patient contact. Intervention to improve the use of gloves and hand hygiene compliance after gloving in the healthcare settings should be implemented.
IMPLICATIONS FOR RESEARCH
Further studies should target poor compliers with glove use and promote strategies that can be evaluated.
Topics: Antisepsis; Cross Infection; Disease Transmission, Infectious; Gloves, Surgical; Hand Hygiene; Health Personnel; Humans; Thailand
PubMed: 26447080
DOI: 10.11124/jbisrir-2015-1817 -
Cureus May 2024Surgical site infections (SSIs) pose a significant clinical challenge, with heightened risks and severe consequences for diabetic patients undergoing surgical... (Review)
Review
Surgical site infections (SSIs) pose a significant clinical challenge, with heightened risks and severe consequences for diabetic patients undergoing surgical procedures. This systematic review aims to synthesize the current evidence on effective prevention strategies for mitigating SSI risk in this vulnerable population. From inception to March 2024, we comprehensively searched multiple electronic databases (PubMed, Medline, Embase, Cochrane Library, CINAHL) to identify relevant studies evaluating SSI prevention strategies in diabetic surgical patients. Our search strategy followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, utilizing a combination of keywords and Medical Subject Headings (MeSH) terms related to diabetes, surgical site infections, prevention strategies, and surgical procedures. Inclusion criteria focused on peer-reviewed clinical trials, randomized controlled trials, and meta-analyses published in English. The search yielded three studies meeting the eligibility criteria, subject to data extraction and qualitative synthesis. Key findings highlighted the efficacy of interventions such as optimized perioperative glycemic control, timely prophylactic antibiotic administration, and meticulous preoperative skin antisepsis in reducing SSI rates among diabetic surgical patients. The potential for personalized prevention approaches based on individual patient factors, such as diabetes type and surgical complexity, was explored. This systematic review underscores the importance of a multifaceted, evidence-based approach to SSI prevention in diabetic surgical patients, integrating strategies like glycemic control, antibiotic prophylaxis, and preoperative skin antisepsis. Furthermore, our findings suggest the potential benefits of personalized care pathways tailored to individual patient characteristics. Implementing these interventions requires interdisciplinary collaboration, adaptation to diverse healthcare settings, and patient engagement through culturally sensitive education initiatives. This comprehensive analysis informs clinical practice, fosters patient safety, and contributes to the global efforts to enhance surgical outcomes for this high-risk population.
PubMed: 38854286
DOI: 10.7759/cureus.59849 -
Ophthalmology Jan 2002To assess commonly used cataract surgery bacterial endophthalmitis prophylaxis techniques based on a systematic literature review and evidence rating. (Review)
Review
PURPOSE
To assess commonly used cataract surgery bacterial endophthalmitis prophylaxis techniques based on a systematic literature review and evidence rating.
CLINICAL RELEVANCE
Prophylactic techniques to decrease the risk of bacterial endophthalmitis related to cataract surgery are commonly used, but the evidence justifying their use is unclear.
LITERATURE REVIEWED
A MEDLINE search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words. Eighty-eight peer-reviewed papers were identified and judged worthy of review on the basis of predefined criteria.
RESULTS
No prophylactic technique received the highest of three possible clinical recommendations (A, crucial to clinical outcome). Preoperative povidone-iodine preparation received the intermediate clinical recommendation (B, moderately important to clinical outcome). All other reported prophylactic interventions, including postoperative subconjunctival antibiotic injection, preoperative lash trimming, preoperative saline irrigation, preoperative topical antibiotics, antibiotic-containing irrigating solutions, and the use of intraoperative heparin, received the lowest clinical recommendation (C, possibly relevant but not definitely related to clinical outcome) based on weak and often conflicting evidence justifying their use.
CONCLUSIONS
With regard to bacterial endophthalmitis prophylaxis in cataract surgery, current literature most strongly supports the use of preoperative povidone-iodine antisepsis.
Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cataract Extraction; Databases, Factual; Endophthalmitis; Evidence-Based Medicine; Eye Infections, Bacterial; Humans; Postoperative Complications; Povidone-Iodine
PubMed: 11772573
DOI: 10.1016/s0161-6420(01)00899-5 -
The Cochrane Database of Systematic... 2004Approximately 15% of elective surgery patients and 30% of patients receiving contaminated or dirty surgery are estimated to develop post-operative wound infections. The... (Review)
Review
BACKGROUND
Approximately 15% of elective surgery patients and 30% of patients receiving contaminated or dirty surgery are estimated to develop post-operative wound infections. The costs of surgical wound infection can be considerable in financial as well as social terms. Preoperative skin antisepsis is performed to reduce the risk of post-operative wound infections by removing soil and transient organisms from the skin. Antiseptics are thought to be both toxic to bacteria and aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however it is unclear whether preoperative skin antisepsis actually reduces post-operative wound infection and if so which antiseptic is most effective.
OBJECTIVES
To determine whether preoperative skin antisepsis reduces post-operative surgical wound infection.
SEARCH STRATEGY
We searched the Cochrane Wounds Group Specialised Trials Register and the Cochrane Central Register of Controlled Trials in April 2004. In addition we handsearched journals, conference proceedings and bibliographies.
SELECTION CRITERIA
Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There were no restrictions based on language, date or publication status.
DATA COLLECTION AND ANALYSIS
Three reviewers independently undertook data extraction and assessment of study quality. Pooling was inappropriate and trials are discussed in a narrative review.
MAIN RESULTS
We identified six eligible RCTs evaluating preoperative antiseptics. There was significant heterogeneity in the comparisons and the results could not be pooled. In one study, infection rates were significantly lower when skin was prepared using chlorhexidine compared with iodine. There was no evidence of a benefit in four trials associated with the use of iodophor impregnated drapes.
REVIEWERS' CONCLUSIONS
There is insufficient research examining the effects of preoperative skin antiseptics to allow conclusions to be drawn regarding their effects on post-operative surgical wound infections. Further research is needed.
Topics: Anti-Infective Agents, Local; Humans; Preoperative Care; Randomized Controlled Trials as Topic; Surgical Wound Infection
PubMed: 15266508
DOI: 10.1002/14651858.CD003949.pub2 -
The Cochrane Database of Systematic... Mar 2013Platelet transfusions are used to prevent and treat bleeding in patients who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Platelet transfusions are used to prevent and treat bleeding in patients who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a small risk of viral, bacterial or protozoal contamination of platelets remains. There is also an ongoing risk from newly emerging blood transfusion-transmitted infections (TTIs) for which laboratory tests may not be available at the time of initial outbreak.One solution to reduce further the risk of TTIs from platelet transfusion is photochemical pathogen reduction, a process by which pathogens are either inactivated or significantly depleted in number, thereby reducing the chance of transmission. This process might offer additional benefits, including platelet shelf-life extension, and negate the requirement for gamma-irradiation of platelets. Although current pathogen-reduction technologies have been proven significantly to reduce pathogen load in platelet concentrates, a number of published clinical studies have raised concerns about the effectiveness of pathogen-reduced platelets for post-transfusion platelet recovery and the prevention of bleeding when compared with standard platelets.
OBJECTIVES
To assess the effectiveness of pathogen-reduced platelets for the prevention of bleeding in patients requiring platelet transfusions.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2013, Issue 1), MEDLINE (1950 to 18 February 2013), EMBASE (1980 to 18 February 2013), CINAHL (1982 to 18 February 2013) and the Transfusion Evidence Library (1980 to 18 February 2013). We also searched several international and ongoing trial databases and citation-tracked relevant reference lists. We requested information on possible unpublished trials from known investigators in the field.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing the transfusion of pathogen-reduced platelets with standard platelets. We did not identify any RCTs which compared the transfusion of one type of pathogen-reduced platelets with another.
DATA COLLECTION AND ANALYSIS
One author screened all references, excluding duplicates and those clearly irrelevant. Two authors then screened the remaining references, confirmed eligibility, extracted data and analysed trial quality independently. We requested and obtained a significant amount of missing data from trial authors. We performed meta-analyses where appropriate using the fixed-effect model for risk ratios (RR) or mean differences (MD), with 95% confidence intervals (95% CI), and used the I² statistic to explore heterogeneity, employing the random-effects model when I² was greater than 30%.
MAIN RESULTS
We included 10 trials comparing pathogen-reduced platelets with standard platelets. Nine trials assessed Intercept® pathogen-reduced platelets and one trial Mirasol® pathogen-reduced platelets. Two were randomised cross-over trials and the remaining eight were parallel-group RCTs. In total, 1422 participants were available for analysis across the 10 trials, of which 675 participants received Intercept® and 56 Mirasol® platelet transfusions. Four trials assessed the response to a single study platelet transfusion (all Intercept®) and six to multiple study transfusions (Intercept® (N = 5), Mirasol® (N = 1)) compared with standard platelets.We found the trials to be generally at low risk of bias but heterogeneous regarding the nature of the interventions (platelet preparation), protocols for platelet transfusion, definitions of outcomes, methods of outcome assessment and duration of follow-up.Our primary outcomes were mortality, 'any bleeding', 'clinically significant bleeding' and 'severe bleeding', and were grouped by duration of follow-up: short (up to 48 hours), medium (48 hours to seven days) or long (more than seven days). Meta-analysis of data from five trials of multiple platelet transfusions reporting 'any bleeding' over a long follow-up period found an increase in bleeding in those receiving pathogen-reduced platelets compared with standard platelets using the fixed-effect model (RR 1.09, 95% CI 1.02 to 1.15, I² = 59%); however, this meta-analysis showed no difference between treatment arms when using the random-effects model (RR 1.14, 95% CI 0.93 to 1.38).There was no evidence of a difference between treatment arms in the number of patients with 'clinically significant bleeding' (reported by four out of the same five trials) or 'severe bleeding' (reported by all five trials) (respectively, RR 1.06, 95% CI 0.93 to 1.21, I² = 2%; RR 1.27, 95% CI 0.76 to 2.12, I² = 51%). We also found no evidence of a difference between treatment arms for all-cause mortality, acute transfusion reactions, adverse events, serious adverse events and red cell transfusion requirements in the trials which reported on these outcomes. No bacterial transfusion-transmitted infections occurred in the six trials that reported this outcome.Although the definition of platelet refractoriness differed between trials, the relative risk of this event was 2.74 higher following pathogen-reduced platelet transfusion (RR 2.74, 95% CI 1.84 to 4.07, I² = 0%). Participants required 7% more platelet transfusions following pathogen-reduced platelet transfusion when compared with standard platelet transfusion (MD 0.07, 95% CI 0.03 to 0.11, I² = 21%), although the interval between platelet transfusions was only shown to be significantly shorter following multiple Intercept® pathogen-reduced platelet transfusion when compared with standard platelet transfusion (MD -0.51, 95% CI -0.66 to -0.37, I² = 0%). In trials of multiple pathogen-reduced platelets, our analyses showed the one- and 24-hour count and corrected count increments to be significantly inferior to standard platelets. However, one-hour increments were similar in trials of single platelet transfusions, although the 24-hour count and corrected count increments were again significantly lower.
AUTHORS' CONCLUSIONS
We found no evidence of a difference in mortality, 'clinically significant' or 'severe bleeding', transfusion reactions or adverse events between pathogen-reduced and standard platelets. For a range of laboratory outcomes the results indicated evidence of some benefits for standard platelets over pathogen-reduced platelets. These conclusions are based on data from 1422 patients included in 10 trials. Results from ongoing or new trials are required to determine if there are clinically important differences in bleeding risk between pathogen-reduced platelet transfusions and standard platelet transfusions. Given the variability in trial design, bleeding assessment and quality of outcome reporting, it is recommended that future trials apply standardised approaches to outcome assessment and follow-up, including safety reporting.
Topics: Antisepsis; Blood Platelets; Furocoumarins; Hemorrhage; Humans; Photosensitizing Agents; Platelet Transfusion; Randomized Controlled Trials as Topic; Riboflavin; Ultraviolet Rays
PubMed: 23543569
DOI: 10.1002/14651858.CD009072.pub2 -
The Cochrane Database of Systematic... Apr 2015Surgical site infection rates in the month following clean surgery vary from 0.6% (knee prosthesis) to 5% (limb amputation). Due to the large number of clean surgical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical site infection rates in the month following clean surgery vary from 0.6% (knee prosthesis) to 5% (limb amputation). Due to the large number of clean surgical procedures conducted annually the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Preoperative skin antisepsis using antiseptics is performed to reduce the risk of SSIs by removing soil and transient organisms from the skin where a surgical incision will be made. Antiseptics are thought to be toxic to bacteria and therefore aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however, it is unclear whether preoperative skin antisepsis actually reduces postoperative wound infection, and, if so, which antiseptic is most effective.
OBJECTIVES
To determine whether preoperative skin antisepsis immediately prior to surgical incision for clean surgery prevents SSI and to determine the comparative effectiveness of alternative antiseptics.
SEARCH METHODS
For this third update we searched just the Cochrane Wounds Group Specialised Register (searched 27 January 2015); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 12).
SELECTION CRITERIA
Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There was no restriction on the inclusion of reports based on language of publication, date or publication status.
DATA COLLECTION AND ANALYSIS
Data extraction and assessment of risk of bias were undertaken independently by two review authors.
MAIN RESULTS
There were no new studies added to the review in the third updateThirteen studies were included in this review (2,623 participants). These evaluated several different types of skin antiseptics - leading to 11 different comparisons being made. Although the antiseptics evaluated differed between studies, all trials involved some form of iodine. Iodine in alcohol was compared to alcohol alone in one trial; one trial compared povidone iodine paint (solution type not reported) with soap and alcohol. Six studies compared different types of iodine-containing products with each other and five compared iodine-containing products with chlorhexidine-containing products.There was evidence from one study suggesting that preoperative skin preparation with 0.5% chlorhexidine in methylated spirits led to a reduced risk of SSI compared with an alcohol based povidone iodine solution: RR 0.47 (95% CI 0.27 to 0.82). However, it is important to note that the trial does not report important details regarding the interventions (such as the concentration of povidone iodine paint used) and trial conduct, such that risk of bias was unclear.There were no other statistically significant differences in SSI rates in the other comparisons of skin antisepsis. Overall the risk of bias in included studies was unclear.A mixed treatment comparison meta-analysis was conducted and this suggested that alcohol-containing products had the highest probability of being effective - however, again the quality of this evidence was low.
AUTHORS' CONCLUSIONS
A comprehensive review of current evidence found some evidence that preoperative skin preparation with 0.5% chlorhexidine in methylated spirits was associated with lower rates of SSIs following clean surgery than alcohol-based povidone iodine paint. However this single study was poorly reported. Practitioners may therefore elect to consider other characteristics such as costs and potential side effects when choosing between alternatives.The design of future trials should be driven by the questions of high priority to decision makers. It may be that investment in at least one large trial (in terms of participants) is warranted in order to add definitive and hopefully conclusive data to the current evidence base. Ideally any future trial would evaluate the iodine-containing and chlorhexidine-containing solutions relevant to current practice as well as the type of solution used (alcohol vs. aqueous).
Topics: Anti-Infective Agents, Local; Chlorhexidine; Ethanol; Humans; Iodine Compounds; Povidone-Iodine; Preoperative Care; Randomized Controlled Trials as Topic; Surgical Wound Infection
PubMed: 25897764
DOI: 10.1002/14651858.CD003949.pub4 -
The Cochrane Database of Systematic... Jan 2008Surgical hand antisepsis, to destroy transient micro-organisms and inhibit the growth of resident micro-organisms, is routinely carried out before undertaking invasive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical hand antisepsis, to destroy transient micro-organisms and inhibit the growth of resident micro-organisms, is routinely carried out before undertaking invasive procedures. Antisepsis may reduce the risk of surgical site infections in patients.
OBJECTIVES
To determine the effects of surgical hand antisepsis on the number of surgical site infections (SSIs) in patients. The secondary objective is to determine the effects of surgical hand antisepsis on the numbers of colony forming units (CFUs) of bacteria on the hands of the surgical team.
SEARCH STRATEGY
We searched the Cochrane Wounds Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials (Issue 2, 2007), MEDLINE (Week 5, 2007), CINAHL (June 2007), EMBASE (Week 23, 2007) and ZETOC (2005).
SELECTION CRITERIA
Randomised controlled trials comparing surgical hand antisepsis of varying duration, methods and antiseptic solutions.
DATA COLLECTION AND ANALYSIS
Three authors independently assessed studies for selection, trial quality and extracted data.
MAIN RESULTS
Ten trials were included in this review. Only one trial reported the primary outcome, rates of SSIs, and nine trials measured numbers of CFUs. One trial involving 4387 patients found alcohol rubs with additional active ingredients were as effective as aqueous scrubs in reducing SSIs. Four trials compared different alcohol rubs containing additional active ingredients with aqueous scrubs for numbers of CFUs on hands. One trial found N-duopropenide more effective than chlorhexidine and povidone iodine aqueous scrubs. One trial found 45% propanol-2, 30% propanol-1 with 0.2% ethylhexadecyldimethyl ammonium ethylsulfate more effective than chlorhexidine scrubs. One trial found no difference between 1% chlorhexidine gluconate in 61% ethyl alcohol or zinc pyrithione in 70% ethyl alcohol against aqueous povidone iodine. A fourth trial found 4% chlorhexidine gluconate scrubs more effective than chlorhexidine in 70% alcohol rubs. Four trials compared the relative effects of different aqueous scrubs in reducing CFUs on hands. Three trials found chlorhexidine gluconate scrubs were significantly more effective than povidone iodine scrubs. One trial found no difference between chlorhexidine gluconate scrubs and povidone iodine plus triclosan scrubs. Two trials found no evidence of a difference between alternative alcohol rubs in terms of the number of CFUs. Four trials compared the effect of different durations of scrubs and rubs on the numbers of CFUs on hands. One trial found no difference after the initial scrub but found subsequent three minute scrubs using chlorhexidine significantly more effective than subsequent scrubs lasting 30 seconds. One trial found that following a one minute hand wash, a three minute rub appears to be more effective than the five minute rub using alcohol disinfectant. The other comparisons demonstrated no difference.
AUTHORS' CONCLUSIONS
Alcohol rubs used in preparation for surgery by the scrub team are as effective as aqueous scrubbing in preventing SSIs however this evidence comes from only one, equivalence, cluster trial which did not appear to adjust for clustering. Four comparisons suggest that alcohol rubs are at least as, if not more, effective than aqueous scrubs though the quality of these is mixed and each study presents a different comparison, precluding meta analysis. There is no evidence to suggest that any particular alcohol rub is better than another. Evidence from 4 studies suggests that chlorhexidine gluconate based aqueous scrubs are more effective than povidone iodine based aqueous scrubs in terms of the numbers of CFUs on the hands. There is limited evidence regarding the effects on CFUs numbers of different scrub durations. There is no evidence regarding the effect of equipment such as brushes and sponges.
Topics: Anti-Infective Agents, Local; Antisepsis; Colony Count, Microbial; General Surgery; Hand; Humans; Randomized Controlled Trials as Topic; Surgical Wound Infection
PubMed: 18254046
DOI: 10.1002/14651858.CD004288.pub2 -
The Cochrane Database of Systematic... Mar 2013Surgical site infection rates in the month following clean surgery vary from 0.6% (knee prosthesis) to 5% (limb amputation). Due to the large number of clean surgical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical site infection rates in the month following clean surgery vary from 0.6% (knee prosthesis) to 5% (limb amputation). Due to the large number of clean surgical procedures conducted annually the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Preoperative skin antisepsis using antiseptics is performed to reduce the risk of SSIs by removing soil and transient organisms from the skin where a surgical incision will be made. Antiseptics are thought to be toxic to bacteria and therefore aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however, it is unclear whether preoperative skin antisepsis actually reduces postoperative wound infection, and, if so, which antiseptic is most effective.
OBJECTIVES
To determine whether preoperative skin antisepsis immediately prior to surgical incision for clean surgery prevents SSI and to determine the comparative effectiveness of alternative antiseptics.
SEARCH METHODS
For this second update we searched the The Cochrane Wounds Group Specialised Register (searched 7 August 2012), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7), Ovid MEDLINE (1950 to July Week 4 2012), Ovid MEDLINE (In-Process & Other Non-Indexed Citations August 06, 2012), Ovid EMBASE (1980 to 2012 Week 31), EBSCO CINAHL (2007 to 3 August 2012).
SELECTION CRITERIA
Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There was no restriction on the inclusion of reports based on language of publication, date or publication status.
DATA COLLECTION AND ANALYSIS
Data extraction and assessment of risk of bias were undertaken independently by two review authors.
MAIN RESULTS
Thirteen studies were included in this review (2,623 participants). These evaluated several different types of skin antiseptics - leading to 11 different comparisons being made. Although the antiseptics evaluated differed between studies, all trials involved some form of iodine. Iodine in alcohol was compared to alcohol alone in one trial; one trial compared povidone iodine paint (solution type not reported) with soap and alcohol. Six studies compared different types of iodine-containing products with each other and five compared iodine-containing products with chlorhexidine-containing products.There was evidence from one study suggesting that preoperative skin preparation with 0.5% chlorhexidine in methylated spirits led to a reduced risk of SSI compared with an alcohol based povidone iodine solution: RR 0.47 (95% CI 0.27 to 0.82). However, it is important to note that the trial does not report important details regarding the interventions (such as the concentration of povidone iodine paint used) and trial conduct, such that risk of bias was unclear.There were no other statistically significant differences in SSI rates in the other comparisons of skin antisepsis. Overall the risk of bias in included studies was unclear.A mixed treatment comparison meta-analysis was conducted and this suggested that alcohol-containing products had the highest probability of being effective - however, again the quality of this evidence was low.
AUTHORS' CONCLUSIONS
A comprehensive review of current evidence found some evidence that preoperative skin preparation with 0.5% chlorhexidine in methylated spirits was associated with lower rates of SSIs following clean surgery than alcohol-based povidone iodine paint. However this single study was poorly reported. Practitioners may therefore elect to consider other characteristics such as costs and potential side effects when choosing between alternatives.The design of future trials should be driven by the questions of high priority to decision makers. It may be that investment in at least one large trial (in terms of participants) is warranted in order to add definitive and hopefully conclusive data to the current evidence base. Ideally any future trial would evaluate the iodine-containing and chlorhexidine-containing solutions relevant to current practice as well as the type of solution used (alcohol vs. aqueous).
Topics: Anti-Infective Agents, Local; Chlorhexidine; Ethanol; Humans; Iodine Compounds; Povidone-Iodine; Preoperative Care; Randomized Controlled Trials as Topic; Surgical Wound Infection
PubMed: 23543526
DOI: 10.1002/14651858.CD003949.pub3 -
British Journal of Perioperative... Jan 2005An underpinning tenet of evidence-based practice is that all routine practices should be open to scrutiny. Questioning practice should not be limited to new,... (Review)
Review
An underpinning tenet of evidence-based practice is that all routine practices should be open to scrutiny. Questioning practice should not be limited to new, experimental procedures, but should also include examination of 'tried and trusted' techniques. Taking this perspective, the author recently contributed to a systematic review evaluating the use of antiseptics preoperatively.
Topics: 2-Propanol; Antisepsis; Chlorhexidine; Disinfectants; Evidence-Based Medicine; Humans; Infection Control; Iodine Compounds; Patient Selection; Practice Guidelines as Topic; Preoperative Care; Randomized Controlled Trials as Topic; Research Design; Skin Care; Solvents; Surgical Wound Infection
PubMed: 15719902
DOI: 10.1177/175045890501500101 -
Journal of Medical Internet Research Apr 2019The increasingly pervasive presence of technology in the operating room raises the need to study the interaction between the surgeon and computer system. A new...
BACKGROUND
The increasingly pervasive presence of technology in the operating room raises the need to study the interaction between the surgeon and computer system. A new generation of tools known as commercial off-the-shelf (COTS) devices enabling touchless gesture-based human-computer interaction is currently being explored as a solution in surgical environments.
OBJECTIVE
The aim of this systematic literature review was to provide an account of the state of the art of COTS devices in the detection of manual gestures in surgery and to identify their use as a simulation tool for motor skills teaching in minimally invasive surgery (MIS).
METHODS
For this systematic literature review, a search was conducted in PubMed, Excerpta Medica dataBASE, ScienceDirect, Espacenet, OpenGrey, and the Institute of Electrical and Electronics Engineers databases. Articles published between January 2000 and December 2017 on the use of COTS devices for gesture detection in surgical environments and in simulation for surgical skills learning in MIS were evaluated and selected.
RESULTS
A total of 3180 studies were identified, 86 of which met the search selection criteria. Microsoft Kinect (Microsoft Corp) and the Leap Motion Controller (Leap Motion Inc) were the most widely used COTS devices. The most common intervention was image manipulation in surgical and interventional radiology environments, followed by interaction with virtual reality environments for educational or interventional purposes. The possibility of using this technology to develop portable low-cost simulators for skills learning in MIS was also examined. As most of the articles identified in this systematic review were proof-of-concept or prototype user testing and feasibility testing studies, we concluded that the field was still in the exploratory phase in areas requiring touchless manipulation within environments and settings that must adhere to asepsis and antisepsis protocols, such as angiography suites and operating rooms.
CONCLUSIONS
COTS devices applied to hand and instrument gesture-based interfaces in the field of simulation for skills learning and training in MIS could open up a promising field to achieve ubiquitous training and presurgical warm up.
Topics: Clinical Competence; General Surgery; Gestures; Humans; Operating Rooms; Technology Transfer
PubMed: 31066679
DOI: 10.2196/11925