Do Adhesive Drapes Have an Effect on Infection Rates in Orthopaedic Surgery? A Systematic Review and Meta-Analysis

Abstract

BackgroundAdhesive surgical drapes are purported to reduce the rates of surgical site infection. Despite that, international surgical guidelines generally recommend against the use of such drapes; however, this is primarily based on nonorthopaedic evidence.Questions/purposes(1) Does the use of adhesive drapes decrease the risk of wound contamination? (2) Does intraoperative drape peeling (intentional or inadvertent) increase the risk of wound contamination? (3) Does the use of adhesive drapes decrease the risk of surgical site infection?MethodsA systematic review of the MEDLINE and Embase databases was performed according to the Cochrane Handbook methods for randomized controlled trials (RCTs) published since 2000 and comparing adhesive drapes with controls. All databases were searched from inception to March 1, 2021. A pooled meta-analysis was performed, where possible. The Cochrane Risk of Bias Assessment Tool was used to assess risk of bias among the included studies. From among 417 search results, five eligible RCTs were identified and included, all of which were published between 2018 and 2020. There were a total of 2266 patients, with 1129 (49.8%) in the adhesive drape groups, and 1137 (50.2%) in the control groups. The studies included hip and knee surgery trials (n = 3 trials; 1020 patients in intervention groups and 1032 patients in control groups) as well as trials on shoulder arthroscopy (n = 1 trial; 65 patients in the intervention group and 61 patients in the control group) and lumbar spine surgery (n = 1 trial; 44 patients in each group). The data for all three outcomes (wound contamination, impact of intraoperative peeling, and surgical site infection) revealed low heterogeneity based on random-effects models (I2 = 14%, 0%, and 0%, respectively).ResultsBased on data from pooled wound swab culture results from four studies, a reduction in wound contamination was associated with the use of adhesive drapes (odds ratio 0.49 [95% CI 0.34 to 0.72]; p < 0.001). The available evidence was inconclusive to determine whether intraoperative drape peeling (intentional or inadvertent) influenced the risk of wound contamination. Three studies did not report on this outcome, one study found an increased infection rate with drape peel back, and another study found a reduced treatment effect of adhesive drapes when peel back occurred in a subgroup analysis. The two studies that analyzed surgical site infections reported no infections in either arm; therefore, we could not answer the question of whether adhesive drapes affect risk of surgical site infection.ConclusionThe findings of this review suggest that adhesive drapes, including those with antimicrobial properties, decrease the risk of wound contamination during orthopaedic procedures. In circumstances where drape adhesion is compromised and peel back occurs at the wound edge, there is an increased risk of wound contamination with the use of adhesive drapes. The best currently available evidence is indeterminate as to the effect of adhesive drapes on the ...

CORR Insights®: Do Adhesive Drapes Have an Effect on Infection Rates in Orthopaedic Surgery? A Systematic Review and Meta-analysis

“…Do we have the data to justify this practice in these areas? The current study [6] found that two of the studies supported routine use of adherent drapes, while two randomized clinical trials showed no difference. The authors could not definitively prove that peeling back the drapes for closure or inadvertent peel back during the procedure was adverse.…”

“…In the current study, Mundi et al [6] performed a meta-analysis of MEDLINE and Embase databases and gathered evidence from randomized controlled trials that compared drapes with controls from 2000 to 2021. They had relatively little to work with; appropriately, they restricted the study to randomized trials, but only four were available in this massive database review that employed a 20-year data pull.…”

“…They had relatively little to work with; appropriately, they restricted the study to randomized trials, but only four were available in this massive database review that employed a 20-year data pull. Based on data from pooled wound swab cultures, Mundi et al [6] found that four studies showed a reduction in wound contamination with the use of adhesive drapes. The findings of this meta-analysis suggest that adhesive drapes, including those with antimicrobial properties, decrease the risk of wound contamination during orthopaedic procedures.…”

The management of fracture related infections: What practices can be supported by high-level evidence?

“…In addition to this, Mundi et al conducted a systematic review and meta-analysis to evaluate if the use of adhesive drapes influenced infection rates in orthopaedic surgery. 27 Five studies and 2266 patients were included. They found a reduction in wound contamination with the use of adhesive drapes (OR 0.49 [95% CI 0.34 to 0.72]; p < 0.001).…”

Research

“…In order to identify whether the evidence supported incise drapes in orthopaedic surgery, a group from Toronto (Canada) set out to systematically review the orthopaedic literature. 5 They identified five randomized controlled trials, and performed a pooled meta-analysis with a total of 2,266 patients undergoing hip, knee, spine, or shoulder procedures. The authors identified that from pooled wound swab culture results, there was a significant reduction in wound contamination rate where adhesive drapes were used.…”