Preoperative bathing or showering with chlorhexidine gluconate in preventing surgical site infections

Abstract

Overview of the topic: Surgical Site Infection (SSI) is the second most common type of healthcare-associated infections. SSIs result in further use of antibiotics, delayed surgical site healing, and are associated with an increased morbidity or mortality. In this dissertation, the use of preoperative chlorhexidine gluconate (CHG) bathing or showering to prevent SSIs will be studied. The research question: Among patients undergoing any type of surgery, is preoperative bathing or showering using chlorhexidine more effective than bathing or showering with a non-antiseptic soap in preventing surgical site infections? PICO elements: The population (P) studied was preoperative patients. The intervention (I) was preoperative CHG bathing. The comparison (C) of interest was bathing with non-antiseptics and the desired outcome (O) was SSIs. Method: The key elements of the PICO question were used as key terms to generate alternative terms. This collection of terms was combined with Boolean Operators. Limiters were applied to narrow down the search results. The combined terms were searched in nine different databases (Table 2.3). The PRISMA 2009 checklist was sued to exclude irrelevant articles. The inclusion/exclusion criteria were applied to assess the eligibility of the articles. The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the key selected studies. Results: A total of six studies were identified. These included three systematic reviews with metaanalysis, one randomised control trial (RCT) and two prospective cohort studies. The systematic reviews identified that CHG used as a skin antiseptic for preoperative bathing has no effect in preventing SSIs while the RCT reported for CHG to increase the risk of SSIs. The three cohort studies reported the effectiveness of CHG antiseptic in preventing SSIs. Conclusion: A concrete conclusion could not be identified since results are inconclusive, although the literature identified pointed out that CHG has the probability to reap benefits, but further research is required to prove its effectiveness. Implications and recommendations: It is recommended that healthcare professionals are educated on the importance of CHG bathing. Education services should be implemented to train healthcare workers on early detection of SSIs, high risk individuals and procedures, CHG guidelines, and patient education on CHG bathing.