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Cyanoacrylate microbial sealants for skin preparation prior to surgery
Allyson Lipp1, Cheryl Phillips, Paul Harris
1Faculty of Health, Sport and Science, Department of Care Sciences, University of South Wales, Glyn Taff Campus, Pontypridd, Rhondda Cynon Taff, UK, CF37 1DL.
Background:
Surgical site infections (i.e. incisions that become infected) are a continuing concern in health care. Microbial sealant is a liquid that can be applied to the skin immediately before surgery and is thought to help reduce the incidence of surgical site infections (SSIs) by sealing in the skin flora, thus preventing contamination and infection of the surgical site.
Objectives:
To assess the effects of the preoperative application of microbial sealants (compared with no microbial sealant) on rates of SSI in people undergoing clean surgery.
Search Methods:
For this first update we searched the following electronic databases in July 2013: the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE - In-Process & Other Non-Indexed Citations, Ovid EMBASE and EBSCO CINAHL.
Selection Criteria:
Randomised controlled trials (RCTs) were eligible for inclusion if they involved people undergoing clean surgery (i.e. surgery that does not involve the breathing system, gut, genital or urinary tract or any part of the body with an existing infection) in an operating theatre and compared the use of preoperative microbial sealants with no microbial sealant.
Data Collection And Analysis:
All review authors independently extracted data on the characteristics, risk of bias and outcomes of the eligible trials.
Main Results:
Three trials (524 participants undergoing clean surgery) met the inclusion criteria. The trials all compared cyanoacrylate microbial sealant with no sealant, and, when pooled, we found there were fewer SSIs with the use of microbial sealant (10/261 participants) than with the control comparison (29/274 participants). The difference between the two groups was statistically significant (risk ratio (RR) 0.36, 95% CI 0.18 to 0.72) but given the number of participants and quality of the studies, they should be treated with caution. There were some adverse events in one study, but these were not judged to be a result of the use of microbial sealant.
Authors' Conclusions:
In this first update there is still insufficient evidence available to determine whether the use of microbial sealants reduces the risk of surgical site infection or not. Further rigorous, adequately-powered RCTs are required to investigate this properly.
Insights
Microbial sealants applied before surgery may reduce surgical site infections (SSIs). However, current evidence is limited, and more high-quality randomized controlled trials (RCTs) are needed to confirm their effectiveness and safety.
Area of Science:
- Infection Control
- Surgical Outcomes
- Medical Device Efficacy
Background:
- Surgical site infections (SSIs) remain a significant healthcare challenge.
- Microbial sealants are applied preoperatively to prevent SSIs by reducing skin flora contamination.
- The efficacy of microbial sealants in preventing SSIs requires robust evaluation.
Purpose of the Study:
- To evaluate the impact of preoperative microbial sealant application on SSI rates in clean surgery.
- To compare outcomes between patients receiving microbial sealant and those receiving no sealant.
- To synthesize evidence from randomized controlled trials (RCTs) on microbial sealant use.
Main Methods:
- Systematic search of multiple electronic databases (Cochrane Wounds, CENTRAL, MEDLINE, EMBASE, CINAHL) up to July 2013.
- Inclusion of randomized controlled trials (RCTs) comparing preoperative microbial sealants with no sealant in clean surgery.
- Independent data extraction and risk of bias assessment by review authors.
Main Results:
- Three RCTs involving 524 participants met the inclusion criteria.
- A pooled analysis indicated fewer SSIs in the microbial sealant group (10/261) versus the control group (29/274), a statistically significant difference (RR 0.36).
- The findings should be interpreted cautiously due to the limited number and quality of included studies; adverse events were minor and not attributed to the sealant.
Conclusions:
- Current evidence is insufficient to definitively conclude whether microbial sealants reduce SSI risk.
- Further rigorous and adequately powered RCTs are necessary to establish the efficacy and safety of microbial sealants.
- The potential benefit of microbial sealants warrants continued investigation with robust study designs.
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