The effectiveness of chlorhexidine in alcohol as skin preparation in reducing the incidence of surgical site infections.

Abstract

Surgical Site Infections (SSIs) are unwanted outcomes after surgery that are on the increase and are resulting in considerable amounts of mortality and morbidity rates each year (Bamard, 2002 & Darouchie et al., 2010). Skin antisepsis aims in reducing the number of viable resident organisms that are found on or in the skin and to destroy pathogenic organisms that may be on the skin as transients (AORN, 2008). The inconsistences in practice regarding which skin solution is more effective triggerred the formulation of this Population, Intervention, Comparison, Outcome (PICO) question; In patients undersgoing surgery (P), is preoperative skin preparation with Chlorhexidine in alcohol solution (I) more effective than an Iodophor solution (C) in reducing the incidence of SSIs (0)? A comprehensive literature search was conducted through several healthcare databases that are available through the UOM, from the local hospital ICU and from other search engines such as the Google Scholar. Additionally, the main key words used for the literature search were "preoperative skin preparation", "prevention of infection", "surgical site infections", "preoperative skin solutions", "chlorhexidine in alcohol versus povidone iodine" and "chlorhexidine in alcohol and iodophor solutions". An inclusion criteria incorporating all the PICO elements was adopted. Conversely, studies comparing scrubbing, hand hygiene, draping, hair shaving and skin preparation prior a local procedure were excluded. The literature search revealed two SRs with meta-analysis and six RCTs. These studies were critically appraised with the help of CASP tools from the Public Health Resource Unit (2006). Findings revealed that the use of chlorhexidine in alcohol is more effective as a skin preparation prior to skin incision when compared to povidone iodine in reducing SSIs. Additionally, it was found that after chlorhexidine use, there was a decrease in positive skin culture. These findings raised recommendations for further education and awareness amongst theatre staff who are preparing the skin prior surgery. This can be done by disseminating the latest evidence on what is more effective amongst colleagues and by stricter adherence to the Infection Control Policy. In conclusion, when presented with EBP, nurses are able to deliver high-quality patient care based on evidence and knowledge rather than rituals, traditions and . suggestions of colleagues (Beyea & Slattery, 2006 & Chard, 2008).