Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Davies, Benjamin; Patel, Hiren C.

doi:10.1308/rcsann.2016.0143

Cited by 27 publications

(26 citation statements)

References 22 publications

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“…Recent evidence advocates for dual‐agent skin antiseptics (eg, CHG and PI) rather than a single agent . Antiseptic agents in combination with alcohol were found to be the most effective in reducing skin contaminants .…”

Section: Strategies To Prevent Ssismentioning

confidence: 99%

Perioperative Strategies for Surgical Site Infection Prevention

Bashaw¹

2018

AORN Journal

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To provide the learner with knowledge of best practices related to perioperative strategies for surgical site infection (SSI) prevention. OBJECTIVES1. Identify contributing patient factors related to SSI development. 2. Identify contributing procedural factors related to SSI development. 3. Describe perioperative best practices to help decrease the incidence of SSIs. 4. Describe two types of skin antiseptic agents that may be used for perioperative skin preparation. ACCREDITATIONAORN is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.ABSTRACT Surgical site infections (SSIs) are some of the most common and costly health care-associated infections. Although the rate of SSIs has declined significantly in the past decade, patient safety remains at risk. Perioperative nurses employ a variety of evidence-based best practices to prevent SSIs and facilitate a safe surgical experience for their patients, including hand hygiene, preoperative patient skin antisepsis, and antimicrobial irrigation. This article explores the causes of SSIs, such as modifiable and nonmodifiable patient factors and preoperative, intraoperative, and postoperative procedural factors, and discusses some of the specific recommended strategies related to the prevention of SSIs that perioperative nurses can initiate in their workplace.

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Section: Strategies To Prevent Ssismentioning

confidence: 99%

Perioperative Strategies for Surgical Site Infection Prevention

Bashaw¹

2018

AORN Journal

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“…1,16,22,23 On the background of our findings from this systematic review, we have conducted a retrospective assessment of our neurosurgical surveillance data from a single center. 37 In a multivariate model, we identified a greater than fivefold benefit for combination CHG and PVI (OR 0.12, CI 0.02 to 0.63). Mechanistically, there is good reason to believe combination CHG and PVI would be of benefit.…”

Section: Discussionmentioning

confidence: 89%

Systematic Review and Meta-Analysis of Preoperative Antisepsis with Combination Chlorhexidine and Povidone-Iodine

Davies

Patel

2016

Surg J

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Surgical site infection (SSI) is a significant cause of postoperative morbidity and mortality, increasing length of hospital stay and cost of care. [1][2][3] SSIs are the second most common cause of health care associated infection; U.S. studies have estimated a $45 billion annual cost. 4 Since Joseph Lister popularized the role of preoperative antisepsis in the 1800s, attempts to identify the optimal process and/or agent have resulted in several trials and much scientific tribulation. 5 Despite this effort, no absolute has emerged; a good example is the efforts to identify which AbstractImportance Effective preoperative antisepsis is recognized to prevent surgical site infection (SSI), although the definitive method is unclear. Many have compared chlorhexidine (CHG) with povidone-iodine (PVI), but there is emerging evidence for combination usage. Objective To conduct a systematic review and meta-analysis to evaluate if combination skin preparation (1) reduces colonization at the operative site and (2) prevents SSI compared with single-agent use. Data Sources A literature search of MEDLINE, Embase, and Cochrane Database of Clinical Trials was performed. Study Selection Comparative, human trials considering the combination use of CHG and PVI, as preoperative antisepsis, to single-agent CHG or PVI use were included. Studies were excluded from meta-analysis if the use or absence of alcohol was inconsistent between study arms. Data Extraction and Synthesis The study was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Main Outcomes and Measures The primary outcome for meta-analysis was surgical site infection. The secondary outcome was colonization at the operative site. Results Eighteen publications with a combination of CHG and PVI use were identified. Of these, 12/14 inferred promise for combination usage, including four trials eligible for meta-analysis. Only one trial reported SSI as its outcome. The remaining three considered bacterial colonization. Combination preparation had a pooled odds ratio for complete decolonization of 5.62 (95% confidence interval 3.2 to 9.7, p < 0.00001). There was no evidence of heterogeneity (Cochran's Q 2.1, 2 df, p ¼ 0.35). Conclusions and Relevance There is emerging, albeit low-quality, evidence in favor of combination CHG and PVI preoperative antisepsis. Further rigorous investigation is indicated.

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“…6 Sequential antiseptic use was associated with reduced risk of a surgical site infection. 5,6,10 Sequential antiseptic use independently reduced the risk of craniotomy surgical site infections 10 and independently reduced the risk of cesarean surgical site infections in class III obese patients. 5 Lastly, sequential antiseptic use reduced the likelihood of central venous catheter colonization.…”

Section: Resultsmentioning

confidence: 99%

Sequential use of povidone-iodine and chlorhexidine for cutaneous antisepsis: A systematic review

Mermel

2019

Infect. Control Hosp. Epidemiol.

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Cutaneous antisepsis with chlorhexidine or povidone-iodine, usually with alcohol, has been extensively studied. This review of published studies reveals that sequential use of povidone-iodine and chlorhexidine leads to a greater reduction in the bioburden of aerobic and anaerobic bacteria on the skin, lower risk of intravascular catheter colonization, and lower risk of surgical site infection compared to use of either agent alone. As such, sequential use of cutaneous antiseptic agents may further reduce risk of surgical site infections, as well as infections associated with insertion of transdermal devices such as nephrostomy tubes, left-ventricular assistance devices, and intravascular catheters.

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Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Cited by 27 publications

References 22 publications

Perioperative Strategies for Surgical Site Infection Prevention

Perioperative Strategies for Surgical Site Infection Prevention

Systematic Review and Meta-Analysis of Preoperative Antisepsis with Combination Chlorhexidine and Povidone-Iodine

Sequential use of povidone-iodine and chlorhexidine for cutaneous antisepsis: A systematic review

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