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Systematic literature review on surgical site preparation in paediatric surgery
Isabella Bielicki1, Ulrike Subotic2, Julia Anna Bielicki3
1Department of Paediatric Surgery, University Children's Hospital Basel, Spitalstr. 33, 4056, Basel, Switzerland. isabella.bielicki@ukbb.ch.
Insights
Evidence is lacking on the best antiseptic agents for surgical skin preparation in children to prevent surgical site infections (SSIs). More high-quality trials are needed to determine optimal methods for reducing SSIs in pediatric patients.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Antiseptic Efficacy
Background:
- Surgical site infections (SSIs) are a significant postoperative complication in children.
- Surgical skin preparation is crucial for preventing SSIs, with chlorhexidine and iodophors commonly used.
- Adult studies suggest chlorhexidine efficacy, but pediatric data is limited.
Purpose of the Study:
- To systematically review the literature on antiseptic agents for surgical skin preparation in children under 16.
- To assess the evidence for different antiseptic agents in reducing SSIs in pediatric surgical patients.
Main Methods:
- Systematic literature review of MEDLINE, EMBASE, CINAHL, and CENTRAL databases.
- Included randomized controlled trials (RCTs) and comparative observational studies.
- Focused on antiseptic agents like chlorhexidine, povidone-iodine, and alcohol for skin preparation.
Main Results:
- Only 8 studies (2 RCTs, 6 observational) met inclusion criteria.
- Included RCTs were of low quality with only 61 pediatric participants.
- No new RCTs comparing antiseptic agents in pediatric surgery since 2016.
Conclusions:
- Robust evidence for optimal skin antisepsis in children is lacking.
- Adult data cannot be directly extrapolated to pediatric populations due to physiological differences.
- High-quality RCTs are essential to identify effective measures for reducing pediatric SSIs.
Background:
Surgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in every surgical procedure. The most commonly used antiseptic agents for surgical skin preparation are chlorhexidine gluconate and iodophors in alcohol-based solutions. In adult patients the use of chlorhexidine-containing antiseptic solutions for preoperative skin preparation has been advocated to reduce SSI rates. Our objective was to conduct a systematic literature review on use of antiseptic agents for surgical skin preparation in children less than 16 years of age.
Methods:
A systematic review of MEDLINE, EMBASE, CINAHL and CENTRAL was performed using both MeSH and free text terms and using the relevant Cochrane filter to identify full text randomized trials (RCTs) and comparative observational studies. Interventions of interest were the choice of main agent in antiseptic solutions (chlorhexidine/povidone-iodine/alcohol) compared with each other or with other antiseptic agents. Primary outcome was the reported rate of surgical site infections.
Results:
In total 8 studies were included in the review; 2 RCTs and 6 observational studies. Observational studies generally did not primarily investigate the association of different antiseptics with subsequent SSI. The identified randomised controlled trials included only 61 children in total, and were of low quality. Consequently, we did not conduct a formal meta-analysis. Since the publication of a comprehensive systematic review of perioperative measures for the prevention of SSI in 2016, no randomized controlled trials comparing antiseptic agents for surgical skin preparation in paediatric surgery have been conducted.
Conclusion:
Robust evidence on the optimal skin antisepsis to reduce SSIs in children is lacking. Direct extrapolation of effects from trials involving adults is not appropriate as physiologic characteristics and risk factors for SSIs differ between adults and children. It is therefore essential to conduct high quality RCT investigating interventions to identify optimal measures to reduce SSI rates in children.
Trial Registration:
Prospero registration ( CRD42020166193 ).
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