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Kamel C, McGahan L, Mierzwinski-Urban M, et al. Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections: A Systematic Review of the Clinical Evidence and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2011 Jun.

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Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections: A Systematic Review of the Clinical Evidence and Guidelines [Internet].

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Appendix 9List of Excluded Studies and Rationale for Exclusion

Comparator Unclear

  • Eiselt D. Presurgical skin preparation with a novel 2% chlorhexidine gluconate cloth reduces rates of surgical site infection in orthopaedic surgical patients. Orthop Nurs. 2009 May;28(3):141–145. [PubMed: 19494763]

Confounding

  • Finkelstein R, Rabino G, Mashiach T, Bar-El Y, Adler Z, Kerztman V, et al. Reducing surgical site infection rates in cardiac surgery: Results of 10-year infection control programme [abstract] Clin Microbiol Infect. 2009;15:S555. (Presented at 19th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) Helsinki Finland;20090516;- 20090519)
  • Maher MM. Preventing mediastinitis: Success with the SCIP bundle and evidence based best practices [abstract] Am J Infect Control. 2009;37(5):E184–E185. (Presented at 36th Annual Educational Conference and International Meeting, APIC Fort Lauderdale, FL United States;20090607;- 20090611)
  • Riley MMS, Pegues D, Suda D, Director U, Tabsh K, Devaskar U. Reduction of low transverse cesarean section-associated surgical site infections [abstract] Am J Infect Control. 2010;38(5):E73–E74. (Presented at APIC 37th Annual Educational Conference and International Meeting New Orleans, LA United States;20100711;- 20100715).
  • Van Kerkhove M, Parsonnet J, Weingart M, Tompkins LS. Investigation of mediastinitis due to coagulase-negative staphylococci after cardiothoracic surgery. Infect Control Hosp Epidemiol. 2006 Mar;27(3):305–307. [PubMed: 16532421]

Duplicate or Preliminary Results

  • Edwards PS, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2004;(3) [PubMed: 15266508]
  • Noorani A, Rabey N, Walsh SR, Davies RJ. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg. 2010 Nov;97(11):1614–1620. [PubMed: 20878942]
  • Open forum. Cochrane review: preoperative skin antisepsis. Br J Perioper Nurs. 2005 May;15(5):191.
  • Paocharoen V, Mingmalairak C, Apisarnthanarak A. Comparison of surgical wound infection after preoperative skin preparation with 4% chlorhexidine [correction of chlohexidine] and povidone iodine: a prospective randomized trial. J Med Assoc Thai. 2009 Jul;92(7):898–902. [PubMed: 19626807]
  • Stewart A, Eyers PS, Earnshaw JJ. Prevention of infection in arterial reconstruction. Cochrane Database Syst Rev (Online). 2006;(3) [PMC free article: PMC8691075] [PubMed: 16855996]
  • Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg. 2007 Jul;46(1):148–155. [PubMed: 17606135]
  • Webster J, Osborne S. Meta-analysis of preoperative antiseptic bathing in the prevention of surgical site infection. Br J Surg. 2006;93(11):1335–1341. [PubMed: 17058326]
  • Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2007;(2) [PubMed: 17443562]
  • Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2010 Dec 6;(1) [PMC free article: PMC10120916] [PubMed: 25927093]

Method Not Reported

Narrative Review or Editorial

  • Crosby CT, Tsj E, Lamber PA, Adams D. Preoperative skin preparation: a historical perspective. Br J Hosp Med. 2009 Oct;70(10):579–582. [PubMed: 19966703]
  • Edmiston CE Jr, Okoli O, Graham MB, Sinski S, Seabrook GR. Evidence for using chlorhexidine gluconate preoperative cleansing to reduce the risk of surgical site infection. AORN J. 2010 Nov;92(5):509–518. [PubMed: 21040815]
  • Galvin P. Cultivating quality: reducing surgical site infections in children undergoing cardiac surgery. Am J Nurs. 2009 Dec;109(12):49–55. [PubMed: 19935173]
  • Hibbard JS. Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review. J Infus Nurs. 2005 May;28(3):194–207. [PubMed: 15912075]
  • La CL, Mangano A, Albertin A. Erratum: Povidone-iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. Is statistical correctness always pursued? Plast Reconstr Surg. 2009;124(3):1013–1014. [PubMed: 19568131]
  • Leaper D, Burman-Roy S, Palanca A, Cullen K, Worster D, Gautam-Aitken E, et al. Prevention and treatment of surgical site infection: summary of NICE guidance. BMJ. 2008;337:a1924. [PubMed: 18957455]
  • Lee JT. Preoperative Skin Preparation. J Am Coll Surg. 2006;202(5):853. [PubMed: 16648028]
  • Lipp A. An evaluation of preoperative skin antiseptics. Br J Perioper Nurs. 2005 Jan;15(1):12–14. [PubMed: 15719902]
  • Mangano A, Albertin A, La CL. Povidone-iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. is statistical correctness always pursued? Plast Reconstr Surg. 2009 Jul;124(1):340–342. [PubMed: 19568131]
  • Murray BW, Huerta S, Dineen S, Anthony T. Surgical site infection in colorectal surgery: a review of the nonpharmacologic tools of prevention. J Am Coll Surg. 2010 Dec;211(6):812–822. [PubMed: 20980173]
  • Spear M. Evidence-based prevention strategies for surgical site infections. Plast Surg Nurs. 2009 Jul;29(3):175–178. [PubMed: 19752686]
  • Wenzel RP. Minimizing surgical-site infections. N Engl J Med. 2010;362(1):75–77. [PubMed: 20054050]
  • Woods A. Key points in the CDC's surgical site infection guideline. Adv Skin Wound Care. 2005 May;18(4):215–220. [PubMed: 15920374]

No Post-operative Assessment

  • Bibbo C, Patel DV, Gehrmann RM, Lin SS. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop. 2005;438:204–208. [PubMed: 16131892]
  • Moen MD, Noone MB, Kirson I. Povidone-iodine spray technique versus traditional scrub-paint technique for preoperative abdominal wall preparation. Am J Obstet Gynecol. 2002 Dec;187(6):1434–1436. [PubMed: 12501042]
  • Ostrander RV, Botte MJ, Brage ME. Efficacy of surgical preparation solutions in foot and ankle surgery. J Bone Joint Surg Am. 2005;87(5):980–985. [PubMed: 15866959]
  • Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am. 2009 Aug;91(8):1949–1953. [PubMed: 19651954]

Not Selected Intervention

  • Hedin H, Larsson S. Technique and considerations when using external fixation as a standard treatment of femoral fractures in children. Injury. 2004 Dec;35(12):1255–1263. [PubMed: 15561115]
  • Schuster JM, Rechtine G, Norvell DC, Dettori JR. The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine. 2010 Apr 20;35(9 Suppl):S125–S137. [PubMed: 20407344]
  • Seibert D. Measured impact of two strategies to lower surgical site infection rates [abstract] Am J Infect Control. 2009;37(5):E48–E49. (Presented at 36th Annual Educational Conference and International Meeting, APIC Fort Lauderdale, FL United States;20090607;- 20090611).

Not Selected Population

  • Culligan P, Kubik K, Murphy M, Blackwell L, Snyder J. A randomized trial that compared providone iodine and chlorhexidine as antiseptics for vaginal hysterectomy. Am J Obstet Gynecol. 2005;192:422–425. [PubMed: 15695981]
  • Hibbard JS, Mulberry GK, Brady AR. A clinical study comparing the skin antisepsis and safety of ChloraPrep, 70% isopropyl alcohol, and 2% aqueous chlorhexidine. J Infus Nurs. 2002 Jul;25(4):244–249. [PubMed: 12131506]
  • Ro K. Methicillin-resistant Staphylococcus aureus colonization: a review of the literature on prevention and eradication. Adv Emerg Nurs J. 2008 Oct;30(4):344–356.
  • Seal LA, Paul-Cheadle D. A Systems approach to preoperative surgical patient skin preparation. Am J Infect Control. 2004 Apr;32(2):57–62. [PubMed: 15057196]
  • Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA. 2006 Nov 22;296(20):2460–2466. [PubMed: 17119142]

Preliminary Results as Abstracts

  • Sammel M, Weed S, Bastek J, Beshara M, Hoffman S, Srinivas SK. New preoperative skin preparation protocol decreases post-cesarean infectious complications [abstract] Am J Obstet Gynecol. 2011;204(1 Suppl):S241. (Presented at 2011 31st Annual Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting San Francisco, CA United States;20110207;- 20110212).

Out of Date Range

  • Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999 Apr;20(4):250–278. [PubMed: 10219875]

Protocol

Systematic Review

  • HAYES. Lansdale (PA): HAYES, Inc.; Preoperative whole-body bathing with chlorhexidine gluconate for prevention of surgical site infection. 2009
  • Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2009 May 12;(1) [PubMed: 15266508]
  • Jakobsson J, Perlkvist A, Wann-Hansson C. Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: a systematic review. Worldviews Evid Based Nurs. 2010 Sep 28 [PubMed: 20880006]
  • Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol. 2010 Dec;31(12):1219–1229. [PMC free article: PMC3833867] [PubMed: 20969449]
  • Noorani A, Rabey N, Walsh S, Davies RJ. Pre-operative antisepsis with chlorhexidine versus povidone-iodine in cleancontaminated surgery: systematic review and meta-analysis of surgical site infection in randomised controlled clinical trials [abstract] Colorectal Dis. 2010;12:36. (Presented at 5th Annual Meeting of the European Society of Coloproctology Sorrento Italy;20100922;- 20100925).
  • Stewart A, Eyers PS, Earnshaw JJ. Prevention of infection in arterial reconstruction. Cochrane Database Syst Rev. 2010 Oct 3;(11)
  • Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2010 Dec 6;(1) [PMC free article: PMC10120916] [PubMed: 25927093]
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