Bath Before an Operation Advised To Reduce Risk for Infection on Operative Site and Use of Regular Bar Soaps

Taking a full-body bath and making a focused washing of the planned operative site reduce the risk of infection on the operative site.  Thus, it is advised for patients to do this before an operation.

The full-body bath and  focused washing of the planned operative site are to be done preferably at least several hours before the scheduled time of the operation.  Depending on the situation and setting, “several hours” is usually  within 6 hours before the scheduled time of the operation.

A bar soap that is being used for daily bath at home by the patient is sufficient.  There is no need to use special soaps such as those containing povidone-iodine and chlorhexidine gluconate.  Studies have shown that bathing using the special soaps does not significantly reduce incidence of infection at the operative site when compared to bath using regular bar soaps.

Below are recent research findings to show that chlorhexidine bath did not significantly reduce overall incidence of surgical site infection when compared with soap, placebo, or no shower or bath.

http://www.ncbi.nlm.nih.gov/pubmed/22722008

Am J Infect Control. 2013 Feb;41(2):167-73. doi: 10.1016/j.ajic.2012.02.014. Epub 2012 Jun 19.

Preoperative chlorhexidine shower or bath for prevention of surgical site infection: a meta-analysis.

Chlebicki MP1Safdar NO’Horo JCMaki DG.

Abstract

BACKGROUND:

Chlorhexidine showering is frequently recommended as an important preoperative measure to prevent surgical site infection (SSI). However, the efficacy of this approach is uncertain.

METHODS:

A search of electronic databases was undertaken to identify prospective controlled trials evaluating whole-body preoperative bathing with chlorhexidine versus placebo or no bath for prevention of SSI. Summary risk ratios were calculated using a DerSimonian-Laird random effects model and a Mantel-Haenzel dichotomous effects model.

RESULTS:

Sixteen trials met inclusion criteria with a total of 17,932 patients: 7,952 patients received a chlorhexidine bath, and 9,980 patients were allocated to various comparator groups. Overall, 6.8% of patients developed SSI in the chlorhexidine group compared with 7.2% of patients in the comparator groups. Chlorhexidine bathing did not significantly reduce overall incidence of SSI when compared with soap, placebo, or no shower or bath (relative risk, 0.90; 95% confidence interval: 0.77-1.05, P = .19).

CONCLUSIONS:

Meta-analysis of available clinical trials suggests no appreciable benefit of preoperative whole-body chlorhexidine bathing for prevention of SSI. However, most studies omitted details of chlorhexidine application. Better designed trials with a specified duration and frequency of exposure to chlorhexidine are needed to determine whether preoperative whole-body chlorhexidine bathing reduces SSI.

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http://www.ncbi.nlm.nih.gov/pubmed/25695511

Cochrane Database Syst Rev. 2015 Feb 20;2:CD004985. [Epub ahead of print]

Preoperative bathing or showering with skin antiseptics to prevent surgical site infection.

Webster J1Osborne S.

Abstract

BACKGROUND:

Surgical site infections (SSIs) are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a lower incidence of surgical site infection.

OBJECTIVES:

To review the evidence for preoperative bathing or showering with antiseptics for preventing hospital-acquired (nosocomial) surgical site infections.

SEARCH METHODS:

For this fifth update we searched the Cochrane Wounds Group Specialised Register (searched 18 December 2014); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014 Issue 11); Ovid MEDLINE (2012 to December Week 4 2014), Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 18, 2014); Ovid EMBASE (2012 to 2014 Week 51), EBSCO CINAHL (2012 to December 18 2014) and reference lists of articles.

SELECTION CRITERIA:

Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in people undergoing surgery.

DATA COLLECTION AND ANALYSIS:

Two review authors independently assessed studies for selection, risk of bias and extracted data. Study authors were contacted for additional information.

MAIN RESULTS:

We did not identify any new trials for inclusion in this fifth update. Seven trials involving a total of 10,157 participants were included. Four of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub/Riohex). Three trials involving 7791 participants compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with placebo did not result in a statistically significant reduction in SSIs; the relative risk of SSI (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 of SSI was 0.95 (95%CI 0.82 to 1.10). Three trials of 1443 participants compared bar soap with chlorhexidine; when combined there was no difference in the risk of SSIs (RR 1.02, 95% CI 0.57 to 1.84). Three trials of 1192 patients compared bathing with chlorhexidine with no washing, one large study found a statistically significant difference in favour of bathing with chlorhexidine (RR 0.36, 95%CI 0.17 to 0.79). The smaller studies found no difference between patients who washed with chlorhexidine and those who did not wash preoperatively.

AUTHORS’ CONCLUSIONS:

This review provides no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated.

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A brand of chlorhexidine shower kit being marketed in the Philippine (Esonex Shower Bath Kit) and being sold in a private hospital costs more than P500 (as of 15mar10)

Personally, I don’t recommend its use.

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In a future blog, I will write bath after an operation advised to reduce risk for infection on operative site and use of regular bar soaps

 ROJ@15mar10

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