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Published on: June 7, 2017
A randomised control trial using soap in the prevention of surgical site infection in Tanzania
Godfrey Sama Philipo1, Zaitun Mohamed Bokhary2, Neema Lala Bayyo3
1Department of Paediatric Surgery, Muhimbili National Hospital, Tanzania; Department of Surgery, Muhimbili University of Health and Allied Sciences, Tanzania; University of Oxford Global Surgery Group (OUGSG), Oxford, UK; University of British Columbia, Branch of Global Surgical Care (BGSC), Vancouver BC, Canada.
Insights
Preoperative bathing with plain soap significantly reduces surgical site infections (SSIs) in children. This simple intervention is a cost-effective method for preventing SSIs in pediatric surgical patients.
Area of Science:
- Infectious Disease Epidemiology
- Surgical Outcomes Research
- Pediatric Surgery
Background:
- Surgical site infections (SSIs) are prevalent and serious surgical complications.
- The efficacy of preoperative bathing with plain soap for preventing SSIs in pediatric populations remains uncertain.
- This study addresses the gap in understanding the role of preoperative bathing in pediatric SSI prevention.
Purpose of the Study:
- To evaluate the effectiveness of preoperative bathing using plain soap in reducing SSIs among pediatric surgical patients.
- To provide evidence-based recommendations for SSI prevention strategies in pediatric surgery.
- To assess the impact of a simple, low-cost intervention on surgical outcomes in children.
Main Methods:
- An open-label, randomized controlled trial was conducted at Muhimbili National Hospital in Tanzania.
- Patients were assigned to either a preoperative bathing group (plain soap) or a control group (no bathing).
- Surgical site infection (SSI) development was the primary outcome, analyzed using logistic regression and other statistical tests.
Main Results:
- The intervention group showed a significantly lower SSI rate (11.4%) compared to the control group (40.6%) (p < 0.01).
- Preoperative bathing reduced the odds of developing an SSI by 80% after adjusting for confounding factors (OR: 0.20).
- The intervention demonstrated a greater reduction in SSI risk (88%) among patients not receiving preoperative antibiotics.
Conclusions:
- Preoperative bathing with plain soap is a highly effective intervention for reducing SSIs in pediatric surgical patients.
- This method is simple, cost-effective, and sustainable for implementation in various healthcare settings.
- The findings support the integration of preoperative bathing into standard pediatric surgical care protocols to minimize infection risk.
Background:
Surgical site infections (SSIs) are common and serious complications of surgery. Guidelines on preventing SSIs have been developed, but the role of preoperative bathing with plain soap among paediatric population is unclear. We aimed to assess the effectiveness of pre-operative bathing using plain soap in preventing SSIs among paediatric surgical patients.
Materials And Methods:
An open-label, randomised trial was conducted at Muhimbili National Hospital in Tanzania. Preoperatively, patients in the intervention group washed their body using plain soap, while those in the control group did not. The primary outcome was SSI postoperatively. Statistical tests included χ2, Wilcoxon rank sum, and univariate and multivariable logistic regression.
Results:
Of the 252 patients recruited,114 were randomised to the intervention arm. In the control arm, 40.6% (56/138) of participants developed SSIs compared to 11.4% (13/114) in the intervention arm (p < 0.01). After adjusting for confounding factors in multivariable analysis, the intervention reduced the odds of an SSI by 80% (OR: 0.20 [95% CI: 0.10, 0.41]; p < 0.01). Preoperative antibiotics were deemed to be an effect modifier of the association between the intervention and SSI (p = 0.05). The intervention significantly reduced the odds of an SSI by 88% among participants not given preoperative antibiotics (OR: 0.12 [95% CI: 0.05, 0.30]; p < 0.01).
Conclusion:
This study has shown that preoperative bathing with soap significantly reduces SSIs in paediatric surgical patients. It is a simple, cost effective and sustainable intervention.
Level Of Evidence:
Level II.
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