Chlorhexidine skin cleansing helps prevent surgical site infection: Lancet

Netherlands: In a new study conducted by Hasti Jalalzadeh and the team, it was found 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 findings of this study were published in The Lancet Microbe.

The most frequent postoperative complication that significantly raises healthcare expenses is surgical site infection. Thus, this study was set to analyze the effectiveness of various skin preparation solutions and concentrations for the prevention of SSIs.

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 searched for randomized controlled trials (RCTs) that directly compared two or more antiseptic chemicals (such as iodine, chlorhexidine, or olanexidine) or concentrations in aqueous and alcohol-based solutions. We looked at pediatric, animal, non-randomized, and trials without the usual preoperative intravenous antibiotic prophylaxis. Two reviewers screened, examined, and evaluated the retrieved data and entire texts that qualified. The main result was the emergence of SSI (ie, deep, superficial, and organ space). To calculate the network effects of skin preparation products on the prevention of SSIs, a frequentist random effects network meta-analysis was done. 

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. Researchers discovered no difference 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. Moderate (I2=275%) heterogeneity was observed among the trials, and netsplitting did not reveal any 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.

In conclusion, no particular alcohol content of chlorhexidine may be advised for clean operation. One randomized experiment was used to determine the effectiveness of olanexidine, and more research is required.

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