Skin Preparation for Prevention of Surgical Site Infection After Cesarean Delivery

Ngai, Ivan; Arsdale, A.R. Van; Govindappagari, Shravya; Judge, Nancy E.; Neto, Nicole; Bernstein, Jeffrey; Bernstein, Peter S.; Garry, David

doi:10.1097/aog.0000000000001118

Cited by 75 publications

(52 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[43, 44] Tuuli et al compared 572 women with chlorhexidine skin preparation with 575 women with iodine skin preparation in a randomized controlled study and demonstrated a decreased rate of wound infection (RR 0.55; 95%CI 0.34, 0.90; P = .02) in patients with chlorhexidine skin preparation [43]. Results from another randomized controlled trial comparing povidone iodine alone ( n = 463), chlorhexidine alone ( n = 474), and both ( n = 467) showed similar wound infection rates, however [44]. The reason for of the different results of these two randomized controlled trials is unclear.…”

Section: Preoperative Managementmentioning

confidence: 99%

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

Kawakita

Landy

2017

matern health, neonatol and perinatol

168

105

View full text Add to dashboard Cite

Cesarean delivery (CD) is one of the most common procedures performed in the United States, accounting for 32% of all deliveries. Postpartum surgical site infection (SSI), wound infection and endometritis is a major cause of prolonged hospital stay and poses a burden to the health care system. SSIs complicate a significant number of patients who undergo CD – 2-7% will experience sound infections and 2-16% will develop endometritis. Many risk factors for SSI have been described. These include maternal factors (such as tobacco use; limited prenatal care; obesity; corticosteroid use; nulliparity; twin gestations; and previous CD), intrapartum and operative factors (such as chorioamnionitis; premature rupture of membranes; prolonged rupture of membranes; prolonged labor, particularly prolonged second stage; large incision length; subcutaneous tissue thickness > 3 cm; subcutaneous hematoma; lack of antibiotic prophylaxis; emergency delivery; and excessive blood loss), and obstetrical care on the teaching service of an academic institution. Effective interventions to decrease surgical site infection include prophylactic antibiotic use (preoperative first generation cephalosporin and intravenous azithromycin), chlorhexidine skin preparation instead of iodine, hair removal using clippers instead of razors, vaginal cleansing by povidone-iodine, placental removal by traction of the umbilical cord instead of by manual removal, suture closure of subcutaneous tissue if the wound thickness is >2 cm, and skin closure with sutures instead of with staples. Implementation of surgical bundles in non-obstetric patients has been promising., Creating a similar patient care bundle comprised evidence-based elements in patients who undergo CD may decrease the incidence of this major complication. Each hospital has the opportunity to create its own CD surgical bundle to decrease surgical site infection.

show abstract

Section: Preoperative Managementmentioning

confidence: 99%

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

Kawakita

Landy

2017

matern health, neonatol and perinatol

168

105

View full text Add to dashboard Cite

show abstract

“…1,11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Only four of these publications were eligible for the meta-analysis. [24][25][26]30 Of the excluded but short-listed studies, 12/14 offered some indication of a role for combination CHG and PVI skin preparation, including 3 studies detailing the implementation of a bundle of care requiring combination skin preparation, 16,22,23 1 letter in favor of its use, 20 5 clinical trials where combination skin preparation was standard practice in both arms, 17,19,[27][28][29] 1 trial in favor of combination CHG and PVI for preoperative nasal decolonisation, 21 1 trial in favor for central line insertion, 1 and 1 basic science study. 11 Only 1 study suggested the combination provided no additional benefit.…”

Section: Resultsmentioning

confidence: 99%

“…7 As a multifactorial problem, it is likely that the effect was hidden, but it poses a hurdle for future investigation. 34 This difficulty can be seen in the RCT by Ngai et al 31 During their study, they found an unexpected low incidence of SSI, which resulted in an underpowered study. Post hoc analysis suggested a sample size of 3,000 would have been required to detect a significant difference.…”

Section: Discussionmentioning

confidence: 99%

“…Post hoc analysis suggested a sample size of 3,000 would have been required to detect a significant difference. 31 Although such a large-scale study would be unusual in surgery, the requirement for improved methods of combatting SSI is clear. SSI significantly contributes to postoperative morbidity and mortality, and with worsening antibiotic resistance, it could become more pertinent.…”

Section: Discussionmentioning

confidence: 99%

“…Only 1 of the 4 eligible studies reported SSI as the outcome. This study was a conference abstract of a randomized controlled trial (RCT) of 1,404 women undergoing cesarean section to preoperative antisepsis with PVI, CHG, or combination CHG and PVI by Ngai et al 26 During analysis, the article was subsequently published in full. 31 The study identified SSI incidences of 4.6% PVI, 4.5% CHG, and 3.9% CHG and PVI.…”

Section: Primary Objective: Does Combination Skin Preparation Reduce mentioning

confidence: 99%

See 2 more Smart Citations

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

Davies

Patel

2016

Surg J

View full text Add to dashboard Cite

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.

show abstract

Skin preparation for preventing infection following caesarean section

Hadiati

Hakimi

Nurdiati

et al. 2018

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Skin Preparation for Prevention of Surgical Site Infection After Cesarean Delivery

Abstract: I.

Cited by 75 publications

References 16 publications

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

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

Skin preparation for preventing infection following caesarean section

Contact Info

Product

Resources

About