Meta-analysis of the use of antiseptics for pre-operative showering to prevent surgical site infection

Background: Preoperative bathing or showering with an antiseptic solution is used to prevent surgical site wound infection. Conflicting trial results suggest a critical review is necessary. \ud Methods: We systematically reviewed randomized controlled trials. Studies were identified by computer searches of Medline, Embase and the Cochrane controlled trials register. Trials were eligible if they compared pre-operative bathing or showering using an antiseptic solution with a non-antiseptic wash agent or with no shower, and if they reported data on surgical site infection.\ud Results: Six trials involving a total of 10,007 participants were included. 4% chlorhexidine gluconate (Hibiscrub) was used in all trials. Three trials involving 7691 participants compared Hibiscrub with a placebo. Bathing with chlorhexidine did not reduce surgical site wound infection rate; the relative risk (RR) was 0.91 (95% confidence interval (CI) 0.80 to 1.04). When only trials of high quality were included in this comparison, the RR was 0.95 (95% CI 0.82 to 1.10). Three trials of 1443 participants compared bar soap with chlorhexidine; no differences in the surgical site infection rates were detected, the RR was 1.02 (95% CI 0.57 to 1.84). Two trials of 1092 patients compared bathing with chlorhexidine with no washing. The surgical site wound infection rate in the two groups was similar, the RR was 0.70 (95% CI 0.19 to 2.58). \ud Conclusions: Current evidence does not support pre-operative showering or bathing with chlorhexidine to reduce surgical site wound infection rates