Preoperative Bathing to Prevent Surgical Site Infection – 2016 WHO Recommendations

New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective

Recommendation 3: preoperative bathing

Good clinical practice requires that patients bathe or shower before surgery. The panel suggests that either a plain or antimicrobial soap can be used for this purpose (conditional recommendation, moderate quality of evidence).

Preoperative whole-body bathing or showering is considered to be good clinical practice to ensure that the skin is as clean as possible before surgery and reduce the bacterial load, particularly at the site of incision. In general, an antiseptic soap is used in settings in which it is available and affordable. We did a systematic review to assess whether using an antiseptic soap for preoperative bathing is more effective in reducing SSIs than using plain soap.

Nine studies (seven RCTs and two observational studies)40,41,42,43,44,45,46,47,48 examined preoperative bathing or showering with an antiseptic soap compared with plain soap. A meta-analysis showed that bathing with a soap containing the antiseptic agent chlorhexidine gluconate did not significantly reduce SSI incidence compared with bathing with plain soap (combined OR 0·92; 95% CI 0·80–1·04). The quality of evidence was rated as moderate. We also assessed whether preoperative bathing with chlorhexidine gluconate-impregnated cloths is more effective than using an antiseptic soap. Very low quality evidence from three observational studies49,50,51 showed that chlorhexidine gluconate cloths were associated with a decrease in SSI compared with no bathing (OR 0·27; 0·09–0·79). In conclusion, either a plain or antiseptic soap can be used for patient preoperative bathing, but the evidence was insufficient to formulate any recommendation on the use of chlorhexidine gluconate-impregnated cloths for the purpose of reducing SSIs.


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