Surgical field and skin preparation.

Area of Science:

• Infection control
• Surgical hygiene
• Healthcare epidemiology

Background:

• Surgical site infection (SSI) is a significant healthcare-associated infection, ranking third in France.
• SSI rates for total hip or knee replacements approximate 2%.
• Skin flora are the primary bacteria implicated in SSIs, highlighting the importance of skin preparation.

Purpose of the Study:

• To review and update guidelines for preventing surgical site infections in France.
• To evaluate the efficacy of different preoperative skin preparation methods.
• To inform best practices for antiseptic use in surgical settings.

Main Methods:

• Review of French national guidelines for SSI prevention updated in 2013 and 2016.
• Analysis of bacteria implicated in SSIs from skin flora.
• Evaluation of evidence for preoperative interventions like hair removal, showering, and antiseptic application.

Main Results:

• Preoperative hair removal and scrubbing of clean skin before asepsis are confirmed as non-contributive to SSI prevention.
• Showering with normal soap close to surgery and using alcoholic antiseptics for skin asepsis are recommended.
• The choice between chlorhexidine and povidone-iodine remains debated due to a lack of multicenter studies and emerging concerns about resistance and side-effects.

Conclusions:

• Current French guidelines prioritize preoperative showering and antiseptic skin preparation for SSI prevention.
• Antimicrobial skin sealants and adhesive surgical drapes are not recommended for preventing SSIs.
• Future antiseptic choices should consider bacterial resistance and potential side-effects, particularly concerning chlorhexidine.