- Title
- Alcoholic chlorhexidine skin preparation or triclosan-coated sutures to reduce surgical site infection: a systematic review and meta-analysis of high-quality randomised controlled trials
- Creator
- Ademuyiwa, Adesoji O.; Adisa, Adewale O.; Bach, Simon; Bhangu, Aneel; Glasbey, James; Kadir, Bryar; Kamarajah, Sivesh K.; Li, Elizabeth; Lillywhite, Rachel; Mann, Harvinder; Moore, Rachel; Morton, Dion; Nepogodiev, Dmitri; Omar, Omar; Simoes, Joana; Smith, Donna; Pinkney, Thomas; Wilkin, Richard; Harrison, Ewen; Smart, Neil; Pockney, Peter
- Relation
- The Lancet Infectious Diseases Vol. 22, Issue 8, p. 1242-1251
- Publisher Link
- http://dx.doi.org/10.1016/S1473-3099(22)00133-5
- Publisher
- Lancet Publishing Group
- Resource Type
- journal article
- Date
- 2022
- Description
- Background: WHO and the UK's National Institute for Health and Care Excellence recommend alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent surgical site infections (SSIs). Existing meta-analyses that include studies at high risk of bias, combined with the recent publication of large, randomised trials, justify an updated meta-analysis of high-quality randomised controlled trials (RCTs). We aimed to test the rates of SSI according to skin preparation solutions (ie, alcoholic chlorhexidine vs aqueous povidone-iodine) and types of sutures (ie, coated vs uncoated). Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, Pubmed, and Cochrane Library databases, with no language restrictions, to identify high-quality RCTs testing either alcoholic chlorhexidine skin preparation (vs aqueous povidone-iodine) or triclosan-coated sutures (vs uncoated sutures), or both, published from database inception to Sept 1, 2021. Patients who received clean-contaminated, contaminated, or dirty surgery were included. We predefined the characteristics of a high-quality trial through an expert consensus process to develop an enhanced Cochrane risk of bias-2 tool specifically for RCTs with a primary outcome of SSI. Data were extracted from published reports. Meta-analysis was performed using a random-effects model and heterogeneity was assessed using the I2 statistic. This systematic review and meta-analysis was prospectively registered in PROSPERO, CRD42021267220. Findings: Of 942 studies identified, 933 were excluded. Four high-quality RCTs (n=7467 patients) were included that tested alcoholic chlorhexidine. No significant difference in SSI rates was noted between alcoholic chlorhexidine and aqueous povidone-iodine (17·9% [667 of 3723 patients] vs 19·8% [740 of 3744 patients]; odds ratio 0·84 [95% CI 0·65–1·06]; p=0·21, I2=53·1%). Five high-quality RCTs were included that tested triclosan-coated sutures (n=8619 patients), with no significant difference noted between triclosan-coated and uncoated sutures (16·8% [733 of 4360 patients] vs 18·4% [784 of 4259 patients]; OR 0·90 [95% CI 0·74–1·09]; p=0·29, I2=36·4%). Interpretation: Contrary to previous meta-analyses, this study did not show a benefit from either alcoholic chlorhexidine skin preparation or triclosan-coated sutures, both of which are more expensive than other readily available alternatives. Global and national guidance should be reconsidered to remove recommendations for their routine use.
- Subject
- alcoholic chlorhexidine; surgical site infections; randomised controlled trials; sutures; triclosan
- Identifier
- http://hdl.handle.net/1959.13/1491559
- Identifier
- uon:53157
- Identifier
- ISSN:1473-3099
- Rights
- © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. https://creativecommons.org/licenses/by-nc-nd/4.0/.
- Language
- eng
- Full Text
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