Reviewers' conclusionsIn people at high risk of pressure ulcer development,consideration should be given to the use of higherspecification foam mattresses rather than standard hospitalfoam mattresses. The relative merits of higher-techconstant low pressure and alternating pressure for

prevention are unclear. Organisations might consider theuse of pressure relief for high risk patients in the operatingtheatre, as this is associated with a reduction inpostoperative incidence of pressure ulcers. Seat cushionsand overlays designed for use in accident and emergencysettings have not been adequately evaluated.

Preoperative skin antiseptics forpreventing surgical wound infection

This review should be cited as: Edwards PS, Lipp A, Holmes A.Preoperative skin antiseptics for preventing surgical woundinfections after clean surgery. (Cochrane ReView) In: TheCochrane Library, Issue 3, 2004. Chichester, UK: John Wiley &Sons, Ltd.

There is insufficient evidence about whether cleaning apatient's skin with antiseptic before 'clean' surgeryreduces wound infections after surgery.

The patient's skin at the operation site is routinelycleaned with antiseptic solutions before surgery. Antisepticskin cleansing before surgery is thought to reduce the riskof postoperative wound infections.

BackgroundApproximately 15% of elective surgery patients and 30%of patients receiving contaminated or dirty surgery areestimated to develop postoperative wound infections.The costs of surgical wound infection can be considerablein financial as well as social terms. Preoperative skinantisepsis is performed to reduce the risk of postoperativewound infections by removing soil and transientorganisms from the skin. Antiseptics are thought to beboth toxic to bacteria and aid their mechanical removal.The effectiveness of preoperative skin preparation isthought to be dependent on both the antiseptic used andthe method of application, however, it is unclear whetherpreoperative skin antisepsis actually reducespostoperative wound infection and if so which antisepticis most effective.

ObjectivesTo determine whether preoperative skin antisepsis reducespostoperative surgical wound infection.

JOURNAL OF TISSUE VIABILITY VOL 14 NO.3 JULY 2004

Search strategyThe Cochrane Wounds Group Specialised Trials Registerand the Cochrane Central Register of Controlled Trials weresearched in April 2004. In addition journals, conferenceproceedings and bibliographies were handsearched.

Selection criteriaTrials selected were randomised controlled trials evaluatingthe use of preoperative skin antiseptics applied immediatelybefore incision in clean surgery. There were no restrictionsbased on language, date or publication status.

Data collection and analysisThree reviewers independently undertook data extractionand assessment of study quality. Pooling was inappropriateand trials are discussed in a narrative review.

Main resultsSix eligible randomised controlled trials were identifiedevaluating preoperative antiseptics. There was significantheterogeneity in the comparisons and the results could notbe pooled. In one study, infection rates were significantlylower when skin was prepared using chlorhexidinecompared with iodine. There was no evidence of a benefitin four trials associated with the use of iodophorimpregnated drapes.

Reviewers' conclusionsThere is insufficient research exarrunrng the effects ofpreoperative skin antiseptics to allow conclusions to bedrawn regarding their effects on postoperative surgicalwound infections. Further research is needed.

113