Practical Recommendations for Preoperative Skin Antisepsis

C.E. Guevara; S.L. Valderrama; C.F. Sefair; J.A. Cortes; M.F. Jimenez; C.G. Soria; L.E. Cuellar; Carlos Arturo Álvarez

doi:10.22354/in.v0i0.704

Practical Recommendations for Preoperative Skin Antisepsis

C.E. Guevara, S.L. Valderrama, C.F. Sefair, J.A. Cortes, M.F. Jimenez, C.G. Soria, L.E. Cuellar, Carlos Arturo Álvarez

Research output: Contribution to journal › Research Article › peer-review

5 Scopus citations

Abstract

The search for strategies for the reduction of Surgical Site infection (SSI) is a priority, given the impact those infections have on the outcome of the patients. The preoperative patient skin antisepsis, has recently gained greater significance in the prevention of SSI, as one of the critical factors, which can be intervened and can reduce the risk of infection. In recent years, comprehensive investigations have been published, not only dedicated to the comparison of antiseptic solutions, application techniques, but also about the importance of preoperative washing, use of surgical tapes and dressings impregnated with antiseptics, and preoperative shaving. This review outlines the key findings related to the preoperative patient's skin antisepsis and offers a protocol with practical recommendations to be implemented in the institutions of our country. It provides evidence based recommendations about the use of antiseptic solutions (povidone iodine, chlorhexidine, chlorhexidine plus alcohol, etc.) with emphasis on the advantages and disadvantages of each one.

Translated title of the contribution	Recomendaciones prácticas para la antisepsia cutánea preoperatoria
Original language	English
Pages (from-to)	46-54
Number of pages	9
Journal	Infectio
Volume	22
Issue number	1
DOIs	https://doi.org/10.22354/in.v0i0.704
State	Published - 2018
Externally published	Yes

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@article{30da3969a4024a88a351b0729f54af87,

title = "Practical Recommendations for Preoperative Skin Antisepsis",

abstract = "La b{\'u}squeda de estrategias para la reducci{\'o}n de la infecci{\'o}n del sitio quir{\'u}rgico (SSI) es una prioridad, dado el impacto que estas infecciones tienen en el resultado de los pacientes. La antisepsia cut{\'a}nea precoz del paciente, ha adquirido recientemente mayor importancia en la prevenci{\'o}n de la SSI, como uno de los factores cr{\'i}ticos, que puede ser intervenido y puede reducir el riesgo de infecci{\'o}n. En los {\'u}ltimos a{\~n}os se han publicado investigaciones exhaustivas, no s{\'o}lo dedicadas a la comparaci{\'o}n de soluciones antis{\'e}pticas, t{\'e}cnicas de aplicaci{\'o}n, sino tambi{\'e}n sobre la importancia del lavado preoperatorio, el uso de cintas y ap{\'o}sitos quir{\'u}rgicos impregnados con antis{\'e}pticos y el afeitado preoperatorio. Esta revisi{\'o}n esboza los principales hallazgos relacionados con la antisepsia cut{\'a}nea del paciente preoperatorio y ofrece un protocolo con recomendaciones pr{\'a}cticas para ser implementado en las instituciones de nuestro pa{\'i}s. Proporciona recomendaciones basadas en la evidencia sobre el uso de soluciones antis{\'e}pticas (povidona yodada, clorhexidina, clorhexidina m{\'a}s alcohol, etc.) con {\'e}nfasis en las ventajas y desventajas de cada una de ellas.",

author = "C.E. Guevara and S.L. Valderrama and C.F. Sefair and J.A. Cortes and M.F. Jimenez and C.G. Soria and L.E. Cuellar and {\'A}lvarez, {Carlos Arturo}",

note = "Export Date: 14 December 2017 Correspondence Address: {\'A}lvarez, C.A.Of 508. Av calle 127 No. 20-78, Colombia References: Yasunaga, H., Ide, H., Imamura, T., Ohe, K., Accuracy of economic studies on surgical site infection (2007) J Hosp Infect, 65, pp. 102-107; Lister, J., On the Antiseptic Principle in the Practice of Surgery (1867) Br Med J, 2, pp. 246-248; Engemann, J.J., Carmeli, Y., Cosgrove, S.E., Fowler, V.G., Bronstein, M.Z., Trivette, S.L., Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection (2003) Clin Infect Dis, 36, pp. 592-598; Coello, R., Glenister, H., Fereres, J., Bartlett, C., Leigh, D., Sedgwick, J., The cost of infection in surgical patients: a case-control study (1993) J Hosp Infect, 25, pp. 239-250; Brenner, F., Nercelles, P., Pohlenz, M., Otaiza, F., Costo de las infecciones intrahospitalarias en hospitales chilenos de alta y mediana complejidad (2003) Rev Chil Infect, 20, pp. 285-290; Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection, 1999 Hospital Infection Control Practices Advisory Committee (1999) Infect Control Hosp Epidemiol, 20, pp. 250-278. , quiz 79-80; Secretaria Distrital de Salud de Bogota. Bolet{\'i}n Epidemiol{\'o}gico de Infecciones asociadas al cuidado de la salud a{\~n}o 2009, , http://www.saludcapital.gov.co/sitios/VigilanciaSaludPublica/SiteCollectionDocuments/BoletinIACS2009.pdf, 2009 [Acceso: julio 2011 2009]; Fajardo Rodriguez, H.A., Quemba Gordillo, J., Eslava Schmalbach, J., [Prediction scales and infection on surgical sites in 15625 surgerie 2001-2003] (2005) Rev Salud Publica (Bogota), 7, pp. 89-98; Yomayusa, N., Gaitan, H., Suarez, I., Ibanez, M., Hernandez, P., Alvarez, C., [Validating prognostic surgical site infection indices from hospitals in Colombia] (2008) Rev Salud Publica (Bogota), 10, pp. 744-755; Alvarez, C.A., Yomayusa, N., Leal, A.L., Moreno, J., Mendez-Alvarez, S., Ibanez, M., Nosocomial infections caused by community-associated methicillinresistant Staphylococcus aureus in Colombia (2010) Am J Infect Control, 38, pp. 315-318; Morales, C.H., Escobar, R.M., Villegas, M.I., Castano, A., Trujillo, J., Surgical site infection in abdominal trauma patients: risk prediction and performance of the NNIS and SENIC indexes (2011) Can J Surg, 54, pp. 17-24; Arias, C.A., Quintero, G., Vanegas, B.E., Rico, C.L., Patino, J.F., Surveillance of surgical site infections: decade of experience at a Colombian tertiary care center (2003) World J Surg, 27, pp. 529-533; Weigelt, J.A., Lipsky, B.A., Tabak, Y.P., Derby, K.G., Kim, M., Gupta, V., Surgical site infections: Causative pathogens and associated outcomes (2010) Am J Infect Control, 38, pp. 112-120; Darouiche, R.O., Wall, M.J., Jr., Itani, K.M., Otterson, M.F., Webb, A.L., Carrick, M.M., Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis (2010) N Engl J Med, 362, pp. 18-26; Kamel, C., McGahan, L., Mierzwinski-Urban, M., Embil, J., Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections, , http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=24354038, A Systematic Review of the Clinical Evidence and Guidelines 2011 citado Julio 2015; Noorani, A., Rabey, N., Walsh, S.R., Davies, R.J., Systematic review and metaanalysis of preoperative antisepsis with chlorhexidine versus povidoneiodine in clean-contaminated surgery (2010) Br J Surg, 97, pp. 1614-1620; Webster, J., Osborne, S., Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (2007) Cochrane Database Syst Rev; Edmiston, C.E., Jr., Okoli, O., Graham, M.B., Sinski, S., Seabrook, G.R., Evidence for using chlorhexidine gluconate preoperative cleansing to reduce the risk of surgical site infection (2010) AORN J, 92, pp. 509-518; Lee, I., Agarwal, R.K., Lee, B.Y., Fishman, N.O., Umscheid, C.A., Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection (2010) Infect Control Hosp Epidemiol, 31, pp. 1219-1229; Edwards, P.S., Lipp, A., Holmes, A., Preoperative skin antiseptics for preventing surgical wound infections after clean surgery (2004) Cochrane Database Syst Rev; Association of Operating Room Nurses (1996) AORN J, 64, pp. 813-816; Anderson, D.J., Kaye, K.S., Classen, D., Arias, K.M., Podgorny, K., Burstin, H., Strategies to prevent surgical site infections in acute care hospitals (2008) Infect Control Hosp Epidemiol, 29, pp. S51-S61; Webster, J., Osborne, S., Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (2015) Cochrane Database Syst Rev, 2; Yomayusa, N., Alvarez, C., Suarez, I., Ibanez, M., Sossa, M., Hernandez, P., Clinical and Molecular Epidemiology of Community Acquired Methicillin-Resistant Staphylococcus aureus Infection in Colombian Hospitals (2006-2007) 48th Annual (ICAAC)/46th Annual Meeting (IDSA), , Washington DC (USA)2008; Poulin, P., Chapman, K., McGahan, L., Austen, L., Schuler, T., Preoperative skin antiseptics for preventing surgical site infections: what to do? (2014) ORNAC J, 32, pp. 12-15 and 24-29; Tanner, J., Woodings, D., Moncaster, K., Preoperative hair removal to reduce surgical site infection (2006) Cochrane Database Syst Rev; Lefebvre, A., Saliou, P., Lucet, J.C., Mimoz, O., Keita-Perse, O., Grandbastien, B., Preoperative hair removal and surgical site infections: network metaanalysis of randomized controlled trials (2015) J Hosp Infect, 91, pp. 100-108; Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N.Z., Zayed, B., Gomes, S.M., New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective (2016) Lancet Infect Dis; Brooks, R.A., Hollinghurst, D., Ribbans, W.J., Severn, M., Bacterial recolonization during foot surgery: a prospective randomized study of toe preparation techniques (2001) Foot Ankle Int, 22, pp. 347-350; Dumville, J.C., McFarlane, E., Edwards, P., Lipp, A., Holmes, A., Liu, Z., Preoperative skin antiseptics for preventing surgical wound infections after clean surgery (2015) Cochrane Database Syst Rev, 4; Culligan, P.J., Kubik, K., Murphy, M., Blackwell, L., Snyder, J., A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy (2005) Am J Obstet Gynecol, 192, pp. 422-425; Ellenhorn, J.D., Smith, D.D., Schwarz, R.E., Kawachi, M.H., Wilson, T.G., McGonigle, K.F., Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites (2005) J Am Coll Surg, 201, pp. 737-741; Echeverri, L., Atehort{\'u}a, S., Tamayo, M., Restrepo, D., Valencia, N., Brote hospitalario de Achromobacter denitrificans relacionado con el uso de clorhexidina contaminada (2012) Infectio, 12, pp. 112-116",

year = "2018",

doi = "10.22354/in.v0i0.704",

language = "Ingl{\'e}s",

volume = "22",

pages = "46--54",

journal = "Infectio",

issn = "0123-9392",

publisher = "Elsevier",

number = "1",

}

TY - JOUR

T1 - Practical Recommendations for Preoperative Skin Antisepsis

AU - Guevara, C.E.

AU - Valderrama, S.L.

AU - Sefair, C.F.

AU - Cortes, J.A.

AU - Jimenez, M.F.

AU - Soria, C.G.

AU - Cuellar, L.E.

AU - Álvarez, Carlos Arturo

N1 - Export Date: 14 December 2017 Correspondence Address: Álvarez, C.A.Of 508. Av calle 127 No. 20-78, Colombia References: Yasunaga, H., Ide, H., Imamura, T., Ohe, K., Accuracy of economic studies on surgical site infection (2007) J Hosp Infect, 65, pp. 102-107; Lister, J., On the Antiseptic Principle in the Practice of Surgery (1867) Br Med J, 2, pp. 246-248; Engemann, J.J., Carmeli, Y., Cosgrove, S.E., Fowler, V.G., Bronstein, M.Z., Trivette, S.L., Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection (2003) Clin Infect Dis, 36, pp. 592-598; Coello, R., Glenister, H., Fereres, J., Bartlett, C., Leigh, D., Sedgwick, J., The cost of infection in surgical patients: a case-control study (1993) J Hosp Infect, 25, pp. 239-250; Brenner, F., Nercelles, P., Pohlenz, M., Otaiza, F., Costo de las infecciones intrahospitalarias en hospitales chilenos de alta y mediana complejidad (2003) Rev Chil Infect, 20, pp. 285-290; Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection, 1999 Hospital Infection Control Practices Advisory Committee (1999) Infect Control Hosp Epidemiol, 20, pp. 250-278. , quiz 79-80; Secretaria Distrital de Salud de Bogota. Boletín Epidemiológico de Infecciones asociadas al cuidado de la salud año 2009, , http://www.saludcapital.gov.co/sitios/VigilanciaSaludPublica/SiteCollectionDocuments/BoletinIACS2009.pdf, 2009 [Acceso: julio 2011 2009]; Fajardo Rodriguez, H.A., Quemba Gordillo, J., Eslava Schmalbach, J., [Prediction scales and infection on surgical sites in 15625 surgerie 2001-2003] (2005) Rev Salud Publica (Bogota), 7, pp. 89-98; Yomayusa, N., Gaitan, H., Suarez, I., Ibanez, M., Hernandez, P., Alvarez, C., [Validating prognostic surgical site infection indices from hospitals in Colombia] (2008) Rev Salud Publica (Bogota), 10, pp. 744-755; Alvarez, C.A., Yomayusa, N., Leal, A.L., Moreno, J., Mendez-Alvarez, S., Ibanez, M., Nosocomial infections caused by community-associated methicillinresistant Staphylococcus aureus in Colombia (2010) Am J Infect Control, 38, pp. 315-318; Morales, C.H., Escobar, R.M., Villegas, M.I., Castano, A., Trujillo, J., Surgical site infection in abdominal trauma patients: risk prediction and performance of the NNIS and SENIC indexes (2011) Can J Surg, 54, pp. 17-24; Arias, C.A., Quintero, G., Vanegas, B.E., Rico, C.L., Patino, J.F., Surveillance of surgical site infections: decade of experience at a Colombian tertiary care center (2003) World J Surg, 27, pp. 529-533; Weigelt, J.A., Lipsky, B.A., Tabak, Y.P., Derby, K.G., Kim, M., Gupta, V., Surgical site infections: Causative pathogens and associated outcomes (2010) Am J Infect Control, 38, pp. 112-120; Darouiche, R.O., Wall, M.J., Jr., Itani, K.M., Otterson, M.F., Webb, A.L., Carrick, M.M., Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis (2010) N Engl J Med, 362, pp. 18-26; Kamel, C., McGahan, L., Mierzwinski-Urban, M., Embil, J., Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections, , http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=24354038, A Systematic Review of the Clinical Evidence and Guidelines 2011 citado Julio 2015; Noorani, A., Rabey, N., Walsh, S.R., Davies, R.J., Systematic review and metaanalysis of preoperative antisepsis with chlorhexidine versus povidoneiodine in clean-contaminated surgery (2010) Br J Surg, 97, pp. 1614-1620; Webster, J., Osborne, S., Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (2007) Cochrane Database Syst Rev; Edmiston, C.E., Jr., Okoli, O., Graham, M.B., Sinski, S., Seabrook, G.R., Evidence for using chlorhexidine gluconate preoperative cleansing to reduce the risk of surgical site infection (2010) AORN J, 92, pp. 509-518; Lee, I., Agarwal, R.K., Lee, B.Y., Fishman, N.O., Umscheid, C.A., Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection (2010) Infect Control Hosp Epidemiol, 31, pp. 1219-1229; Edwards, P.S., Lipp, A., Holmes, A., Preoperative skin antiseptics for preventing surgical wound infections after clean surgery (2004) Cochrane Database Syst Rev; Association of Operating Room Nurses (1996) AORN J, 64, pp. 813-816; Anderson, D.J., Kaye, K.S., Classen, D., Arias, K.M., Podgorny, K., Burstin, H., Strategies to prevent surgical site infections in acute care hospitals (2008) Infect Control Hosp Epidemiol, 29, pp. S51-S61; Webster, J., Osborne, S., Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (2015) Cochrane Database Syst Rev, 2; Yomayusa, N., Alvarez, C., Suarez, I., Ibanez, M., Sossa, M., Hernandez, P., Clinical and Molecular Epidemiology of Community Acquired Methicillin-Resistant Staphylococcus aureus Infection in Colombian Hospitals (2006-2007) 48th Annual (ICAAC)/46th Annual Meeting (IDSA), , Washington DC (USA)2008; Poulin, P., Chapman, K., McGahan, L., Austen, L., Schuler, T., Preoperative skin antiseptics for preventing surgical site infections: what to do? (2014) ORNAC J, 32, pp. 12-15 and 24-29; Tanner, J., Woodings, D., Moncaster, K., Preoperative hair removal to reduce surgical site infection (2006) Cochrane Database Syst Rev; Lefebvre, A., Saliou, P., Lucet, J.C., Mimoz, O., Keita-Perse, O., Grandbastien, B., Preoperative hair removal and surgical site infections: network metaanalysis of randomized controlled trials (2015) J Hosp Infect, 91, pp. 100-108; Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N.Z., Zayed, B., Gomes, S.M., New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective (2016) Lancet Infect Dis; Brooks, R.A., Hollinghurst, D., Ribbans, W.J., Severn, M., Bacterial recolonization during foot surgery: a prospective randomized study of toe preparation techniques (2001) Foot Ankle Int, 22, pp. 347-350; Dumville, J.C., McFarlane, E., Edwards, P., Lipp, A., Holmes, A., Liu, Z., Preoperative skin antiseptics for preventing surgical wound infections after clean surgery (2015) Cochrane Database Syst Rev, 4; Culligan, P.J., Kubik, K., Murphy, M., Blackwell, L., Snyder, J., A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy (2005) Am J Obstet Gynecol, 192, pp. 422-425; Ellenhorn, J.D., Smith, D.D., Schwarz, R.E., Kawachi, M.H., Wilson, T.G., McGonigle, K.F., Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites (2005) J Am Coll Surg, 201, pp. 737-741; Echeverri, L., Atehortúa, S., Tamayo, M., Restrepo, D., Valencia, N., Brote hospitalario de Achromobacter denitrificans relacionado con el uso de clorhexidina contaminada (2012) Infectio, 12, pp. 112-116

PY - 2018

Y1 - 2018

N2 - La búsqueda de estrategias para la reducción de la infección del sitio quirúrgico (SSI) es una prioridad, dado el impacto que estas infecciones tienen en el resultado de los pacientes. La antisepsia cutánea precoz del paciente, ha adquirido recientemente mayor importancia en la prevención de la SSI, como uno de los factores críticos, que puede ser intervenido y puede reducir el riesgo de infección. En los últimos años se han publicado investigaciones exhaustivas, no sólo dedicadas a la comparación de soluciones antisépticas, técnicas de aplicación, sino también sobre la importancia del lavado preoperatorio, el uso de cintas y apósitos quirúrgicos impregnados con antisépticos y el afeitado preoperatorio. Esta revisión esboza los principales hallazgos relacionados con la antisepsia cutánea del paciente preoperatorio y ofrece un protocolo con recomendaciones prácticas para ser implementado en las instituciones de nuestro país. Proporciona recomendaciones basadas en la evidencia sobre el uso de soluciones antisépticas (povidona yodada, clorhexidina, clorhexidina más alcohol, etc.) con énfasis en las ventajas y desventajas de cada una de ellas.

AB - La búsqueda de estrategias para la reducción de la infección del sitio quirúrgico (SSI) es una prioridad, dado el impacto que estas infecciones tienen en el resultado de los pacientes. La antisepsia cutánea precoz del paciente, ha adquirido recientemente mayor importancia en la prevención de la SSI, como uno de los factores críticos, que puede ser intervenido y puede reducir el riesgo de infección. En los últimos años se han publicado investigaciones exhaustivas, no sólo dedicadas a la comparación de soluciones antisépticas, técnicas de aplicación, sino también sobre la importancia del lavado preoperatorio, el uso de cintas y apósitos quirúrgicos impregnados con antisépticos y el afeitado preoperatorio. Esta revisión esboza los principales hallazgos relacionados con la antisepsia cutánea del paciente preoperatorio y ofrece un protocolo con recomendaciones prácticas para ser implementado en las instituciones de nuestro país. Proporciona recomendaciones basadas en la evidencia sobre el uso de soluciones antisépticas (povidona yodada, clorhexidina, clorhexidina más alcohol, etc.) con énfasis en las ventajas y desventajas de cada una de ellas.

U2 - 10.22354/in.v0i0.704

DO - 10.22354/in.v0i0.704

M3 - Artículo de Investigación

SN - 0123-9392

VL - 22

SP - 46

EP - 54

JO - Infectio

JF - Infectio

IS - 1

ER -

Practical Recommendations for Preoperative Skin Antisepsis

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