Saline irrigation and wound infection in abdominal gynecologic surgery

Ramahi, Mahmoud; Bata, M.; Sumreen, I.; Amr, Mahmoud A.

doi:10.1016/j.ijgo.2006.03.030

Cited by 18 publications

(27 citation statements)

References 8 publications

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“…Twenty-one RCTs were identified comparing wound irrigation with no wound irrigation in patients undergoing various surgical procedures, and the results were substantially heterogeneous [51] Saline irrigation was not effective in reducing SSIs [52]. However, when the saline was applied with a syringe to generate some pressure [53], a reduction in the risk of SSI compared with no irrigation was shown in one study (OR 0.35; 95% CI 0.19-0.65; P = 0.0009).…”

Section: Resultsmentioning

confidence: 99%

Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

Simone¹,

Sartelli

Coccolini

et al. 2020

World J Emerg Surg

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Background: Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intraabdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. Methods: The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES.Results: Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI.Conclusions: The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.

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Section: Resultsmentioning

confidence: 99%

Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

Simone¹,

Sartelli

Coccolini

et al. 2020

World J Emerg Surg

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“…We excluded studies for the following reasons: use of quasi‐randomisation (14 studies: Al‐Ramahi 2006 ; Bertheussen 1980 ; Bhargava 2006 ; Geraghty 1984 ; Iqbal 1998 ; Kellum 1985 ; Ko 1992 ; Makvandi 2014 ; Nachamie 1968 ; Nomikos 1986 ; Noon 1967 ; Rogers 1983 ; Salvati 1988 ; Sood 1985 ); or lack of randomisation only apparent after translation or study author contact (two studies: Terzi 2015 ; Wu 1992 ); use of perioperative irrigation was not the only systematic difference between groups (20 studies: Alcantara 2011 ; Badia 1994 ; Bennett‐Guerrero 2016 ; Boothby 1984 ; Donnenfeld 1986 ; Ducharme 1986 ; Fountas 1999 ; Freischlag 1984 ; Garg 2013 ; Gonen 1986 ; Kothuis 1981 ; Mathelier 1992 ; Pollock 1978 ; Sarr 1988 ; Sauven 1986 ; Scheuerlein 2000 ; Shapiro 1986 ; Toki 1995 ; White 2008 ; Xiao 2010 ); the study enrolled participants from a different patient population ‐ some or all participants did not undergo surgery (eight studies: Chisholm 1992 ; Ghafouri 2016a ; Ghafouri 2016b ; Granick 2007 ; Longmire 1987 ; Morse 1998 ; Rosen 1985 ; Weiss 2013 ) or there was healing by delayed primary or secondary intention in so...…”

Section: Resultsmentioning

confidence: 99%

Intracavity lavage and wound irrigation for prevention of surgical site infection

Norman

Atkinson

Smith

et al. 2017

Cochrane Database of Systematic Reviews

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BackgroundSurgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery.ObjectivesTo assess the effects of wound irrigation and intracavity lavage on the prevention of surgical site infection (SSI).Search methodsIn February 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions on language, date of publication or study setting.Selection criteriaWe included all randomised controlled trials (RCTs) of participants undergoing surgical procedures in which the use of a particular type of intraoperative washout (irrigation or lavage) was the only systematic difference between groups, and in which wounds underwent primary closure. The primary outcomes were SSI and wound dehiscence. Secondary outcomes were mortality, use of systemic antibiotics, antibiotic resistance, adverse events, re-intervention, length of hospital stay, and readmissions.Data collection and analysisTwo review authors independently assessed studies for inclusion at each stage. Two review authors also undertook data extraction, assessment of risk of bias and GRADE assessment. We calculated risk ratios or differences in means with 95% confidence intervals where possible.Main resultsWe included 59 RCTs with 14,738 participants. Studies assessed comparisons between irrigation and no irrigation, between antibacterial and non-antibacterial irrigation, between different antibiotics, different antiseptics or different non-antibacterial agents, or between different methods of irrigation delivery. No studies compared antiseptic with antibiotic irrigation.Surgical site infectionIrrigation compared with no irrigation (20 studies; 7192 participants): there is no clear difference in risk of SSI between irrigation and no irrigation (RR 0.87, 95% CI 0.68 to 1.11; I2 = 28%; 14 studies, 6106 participants). This would represent an absolute difference of 13 fewer SSIs per 1000 people treated with irrigation compared with no irrigation; the 95% CI spanned from 31 fewer to 10 more SSIs. This was low-certainty evidence downgraded for risk of bias and imprecision.Antibacterial irrigation compared with non-antibacterial irrigation (36 studies, 6163 participants): there may be a lower incidence of SSI in participants treated with antibacterial ir...

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“…Due to this heterogeneity of the evidence, nine separate comparisons were composed. Five studies describing intraoperative peritoneal cavity irrigation (20)(21)(22)(23)(24) comparing saline solution vs. no irrigation (20), taurolidine vs. saline solution (21) and antibiotic irrigation vs saline or no irrigation (22)(23)(24); fifteen describing incisional wound irrigation (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) comparing saline solution vs. no irrigation (25), syringe pressure irrigation with saline solution vs. no irrigation (26), pulse pressure irrigation with saline solution vs. normal saline solution (27,28), aqueous povidone iodine (PVP-I) vs. saline solution (29)(30)(31)(32)(33)(34)(35) and antibiotic vs. saline solution or no irrigation (22,(36)(37)(38)(39); and one study describing intraoperative mediastinal cavity irrigation (40) comparing aqueous PVP-I vs. saline solution. Most studies were conducted in patients undergoing abdominal surgery…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Regarding incisional wound irrigation, mere saline irrigation was not effective in reducing SSIs (25). However, when the saline solution was applied with a syringe to generate some pressure (26) a reduction in the risk of SSI compared to no irrigation was shown in one study (OR 0.35 (95% CI: 0.19-0.65); P=0.0009).…”

Section: Data and Analysesmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections

Jonge

Boldingh

Solomkin

et al. 2017

Surgical Infections

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Saline irrigation and wound infection in abdominal gynecologic surgery

Abstract: Saline wound irrigation before abdominal wall closure is not helpful in decreasing the incidence of wound infection after abdominal gynecologic surgery.

Cited by 18 publications

References 8 publications

Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

Intracavity lavage and wound irrigation for prevention of surgical site infection

Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections

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