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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 -
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 -
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