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Reviewers' conclusions In people at high risk of pressure ulcer development, consideration should be given to the use of higher specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. Organisations might consider the use of pressure relief for high risk patients in the operating theatre, as this is associated with a reduction in postoperative incidence of pressure ulcers. Seat cushions and overlays designed for use in accident and emergency settings have not been adequately evaluated. Preoperative skin antiseptics for preventing surgical wound infection This review should be cited as: Edwards PS, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. (Cochrane ReView) In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. T here is insufficient evidence about whether cleaning a patient's skin with antiseptic before 'clean' surgery reduces wound infections after surgery. The patient's skin at the operation site is routinely cleaned with antiseptic solutions before surgery. Antiseptic skin cleansing before surgery is thought to reduce the risk of postoperative wound infections. Background Approximately 15% of elective surgery patients and 30% of patients receiving contaminated or dirty surgery are estimated to develop postoperative wound infections. The costs of surgical wound infection can be considerable in financial as well as social terms. Preoperative skin antisepsis is performed to reduce the risk of postoperative wound infections by removing soil and transient organisms from the skin. Antiseptics are thought to be both toxic to bacteria and aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however, it is unclear whether preoperative skin antisepsis actually reduces postoperative wound infection and if so which antiseptic is most effective. Objectives To determine whether preoperative skin antisepsis reduces postoperative surgical wound infection. JOURNAL OF TISSUE VIABILITY VOL 14 NO.3 JULY 2004 Search strategy The Cochrane Wounds Group Specialised Trials Register and the Cochrane Central Register of Controlled Trials were searched in April 2004. In addition journals, conference proceedings and bibliographies were handsearched. Selection criteria Trials selected were randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately before incision in clean surgery. There were no restrictions based on language, date or publication status. Data collection and analysis Three reviewers independently undertook data extraction and assessment of study quality. Pooling was inappropriate and trials are discussed in a narrative review. Main results Six eligible randomised controlled trials were identified evaluating preoperative antiseptics. There was significant heterogeneity in the comparisons and the results could not be pooled. In one study, infection rates were significantly lower when skin was prepared using chlorhexidine compared with iodine. There was no evidence of a benefit in four trials associated with the use of iodophor impregnated drapes. Reviewers' conclusions There is insufficient research exarrunrng the effects of preoperative skin antiseptics to allow conclusions to be drawn regarding their effects on postoperative surgical wound infections. Further research is needed. 113
