Skin preparation before surgery: options and evidence.

Area of Science:

• Infection Control
• Surgical Asepsis
• Antiseptic Efficacy

Background:

• Surgical site infection (SSI) remains a significant challenge despite advances in surgical asepsis.
• Pre-operative skin decontamination is standard, but the optimal antiseptic agent is debated.

Purpose of the Study:

• To review and evaluate the efficacy of different pre-operative skin antiseptic agents in reducing SSI.
• To compare chlorhexidine-based and iodine-based solutions, with and without alcohol.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and observational studies.
• Analysis of data comparing various antiseptic preparations for pre-operative skin decontamination.

Main Results:

• Alcohol-based preparations showed a high probability of reducing SSI risk compared to aqueous-based ones.
• Chlorhexidine-isopropyl alcohol demonstrated superior skin decontamination compared to povidone-iodine combinations.
• Large RCTs suggest chlorhexidine-isopropyl alcohol significantly reduces SSI in clean-contaminated surgery.

Conclusions:

• Alcohol-based antiseptics are likely superior to aqueous agents for preventing SSIs.
• Chlorhexidine-isopropyl alcohol may offer better pre-operative skin decontamination than iodine-based alternatives.
• High-quality, powered RCTs are needed to determine the optimal, cost-effective skin preparation for diverse surgical procedures.