Chlorhexidine and olanexidine most effective for preventing SSIs in all types of surgical wounds: Lancet

A new study published in The Lancet Microbe suggests that the best method for preventing surgical site infection (SSI) in adult patients undergoing surgery for any type of wound is skin preparation with either 2–0–5% chlorhexidine in alcohol or 1–5% olanexidine.

The most frequent postoperative complication that significantly raises healthcare expenses is surgical site infection. There are discrepancies between published meta-analyses and international standards about the most effective preoperative skin antiseptic solution and concentration. In order to assess the effectiveness of various skin preparation solutions and dosages for the prevention of SSIs and to present an overview of existing guidelines, Hasti Jalalzadeh and colleagues undertook this study.

In this systematic review and network meta-analysis, several preoperative skin antiseptics were evaluated in the prevention of surgical site infections (SSIs) in adult patients having surgery for any type of wound. In MEDLINE, Embase, and Cochrane CENTRAL, researchers looked for randomized controlled trials (RCTs) that directly evaluated two or more antiseptic agents or dosages in aqueous and alcohol-based solutions. Animal, pediatric, and non-randomized trials were also disqualified, along with studies that did not administer the usual preoperative intravenous antibiotic prophylaxis. The quantitative analysis eliminated studies with no SSIs in either group. Two reviewers screened, examined, and evaluated the retrieved data and entire texts that qualified. The incidence of SSI was the main result. To calculate the network effects of skin preparation products on the prevention of SSIs, a frequentist random effects network meta-analysis was done. To assess the degree of confidence of the evidence, a risk-of-bias and Grading of Recommendations, Evaluation, Development, and Evaluation assessment was completed.

The key findings of this study were:

1. Overall, 2326 papers were found, 33 research qualified for the systematic review, and 27 studies reporting 2144 SSIs among 17 735 patients were included in the quantitative analysis.

2. In comparison to aqueous iodine, only 2–2–5% chlorhexidine in alcohol and 1–5% olanexidine significantly decreased the risk of SSIs.

3. No difference was discovered in effectiveness between various chlorhexidine in alcohol concentrations for clean surgery.

4. Two RCTs had a minimal risk of bias, 24 had some issues, and seven had a high risk.

5. The papers' heterogeneity was moderate, and netsplitting revealed no discrepancies between direct and indirect comparisons.

6. No significant difference in adverse events across groups was found in any of the five studies that mentioned no adverse events and five that reported a total of 56 mild incidents out of the ten that mentioned adverse events connected to the skin preparation solutions.

Reference: 

Jalalzadeh, H., Groenen, H., Buis, D. R., Dreissen, Y. E., Goosen, J. H., Ijpma, F. F., van der Laan, M. J., Schaad, R. R., Segers, P., van der Zwet, W. C., Griekspoor, M., Harmsen, W. J., Wolfhagen, N., & Boermeester, M. A. (2022). Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis. In The Lancet Microbe (Vol. 3, Issue 10, pp. e762–e771). Elsevier BV. https://doi.org/10.1016/s2666-5247(22)00187-2