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Surgical field and skin preparation

Sarah Jolivet1, Jean-Christophe Lucet1

  • 1IAME, UMR 1137, Inserm, université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France; UHLIN, hôpital Bichat, AP-HP, 75018 Paris, France.

Orthopaedics & Traumatology, Surgery & Research : OTSR
|November 6, 2018
PubMed

Insights

Surgical site infections (SSI) are common in hip or knee replacements. Current guidelines emphasize preoperative showering and antiseptic skin preparation, while advising against hair removal and certain skin sealants.

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.
Keywords:
Prevention of infectionSkin preparationSurgical site infection

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