Wound infection is one of the frequent complications of surgical procedures, and this problem is particularly prominent in low-income countries. The incidence of wound infection can be reduced to a great extent if effective preventive measures are taken preoperatively. So, what precautions should be taken preoperatively to reduce the incidence of wound infection?
I. For patients taking immunosuppressive drugs, is it necessary to discontinue immunosuppressive drugs before surgery?
Current evidence shows that discontinuing immunosuppressive drugs does not reduce the risk of wound infection, and that discontinuing immunosuppressive drugs may or may not aggravate the activity of pre-existing disease, so it is not considered necessary to discontinue immunosuppressive drugs in general. Considering that the available evidence is not of high quality, the experts set the strength of recommendation to: conditional recommendation (low).
II. Is preoperative nutritional support necessary?
After meta-analysis of the available studies, experts found that preoperative multiplenutrient-enhanced nutritional formulas can reduce the risk of wound infection, but single-component nutritional support does not reduce the risk of wound infection. The quality of the available evidence is not very high, and the nutritional support itself can increase the financial burden of patients and use more medical resources, so experts believe that multiple nutritional support can be considered only for patients with low body weight. The recommended intensity is still: conditional recommendation (low).
Third, do patients need to wash their skin with antibacterial soap before surgery?
After a meta-analysis of the available studies, experts found that: antibacterial soap is not more effective than regular soap for disinfection, and the available evidence is of moderate quality. In addition, although there are some studies that support the idea that wiping hands with chlorhexidine gluconate-impregnated hand towels reduces the risk of wound infection, the available studies are of very low quality and are only observational studies. Therefore, experts agree that preoperative skin cleansing is needed, with either antibacterial or regular soap, but there is no need to use chlorhexidine gluconate-impregnated hand towels for hand wiping. The strength of recommendation for this measure is: conditional recommendation (low).
IV. In patients with Staphylococcus aureus colonization of the nasopharynx who are proposed to undergo ambulatory surgery/orthopedic surgery or other types of surgery, is preoperative application of mupirocin cream required?
In a meta-analysis of 6 RCTs, experts found that in patients with S. aureus colonization of the nasopharynx, the use of 2% mupirocin cream, with or without chlorhexidine irrigation, significantly reduced the incidence of wound infection.
Although four of the six RCTs were conducted in patients undergoing thoracic and orthopedic surgery, meta-regression analysis showed that the type of surgery does not affect the effect of mupirocin, and most of the studies available were of moderate quality for the studies that were available.
The WHO experts also emphasized that it is important to first It must be clear that the patient is a carrier of Staphylococcus aureus in the nasopharynx, otherwise it may lead to antibiotic abuse.
Do patients undergoing elective colorectal surgery require mechanical bowel preparation (MBP)? Is oral antibiotics necessary in conjunction with mechanical bowel preparation (MBP)?
After analyzing the available studies, experts concluded that MBP alone does not reduce the incidence of wound infections, taking into account that MBP itself has certain side effects, such as electrolyte disturbances. Therefore, MBP alone is not recommended to reduce wound infections. The recommended intensity is: MBP alone is strongly not recommended.
VI. Is it necessary to prepare the skin before surgery? How to prepare the skin?
There are currently three options for skin preparation: shaving, clipping, and depilatorycream. Fifteen RCTs compared the effectiveness of these three skin preparation methods in preventing wound infection.
After a meta-analysis of these studies, experts noted that the available studies showed that the incidence of wound infection was not affected by either method of skin preparation. In other words, it doesn’t matter if the skin is prepared or not. However, if the results of each skin preparation method are compared individually, shaving is superior to shaving. Therefore, for whether and how to prepare the skin, experts conclude that it is up to the surgeon to decide whether to prepare the skin (for example, if it blocks the surgical view, it is recommended), but if it is to be prepared, shaving is recommended instead of shaving.
VII. What is the optimal time for prophylactic antibiotic use?
The available studies are mostly observational and lack information on pediatric patients. An analysis of these studies showed that prophylactic antibiotics were best administered within 120 minutes before surgery. Although the conventional wisdom is that prophylactic antibiotics should be administered within 60 minutes before surgery, the evidence suggests that prophylactic antibiotics administered 60 minutes before surgery are as effective as prophylactic antibiotics administered 120 minutes before surgery. Therefore, experts say that prophylactic antibiotics should be administered within 120 minutes prior to surgery. The specific time when to do this requires the surgeon to consider the metabolic kinetics of the drug, the expected time of surgery, and other factors.
What should I wash my hands with before surgery? How to wash hands?
There are currently two main ways to wash hands in the operating room: first, with antibacterial soap followed by rinsing with water; second, directly with chlorhexidine disinfection. After compiling the available studies, WHO experts found that the risk of wound infection from both types of hand sanitizers was the same. In addition, experts found that the risk of wound infection was the same whether scrubbing was done gently (rubbing) or vigorously (scrubbing). Therefore, experts recommend: preoperative hand washing, using antibacterial soap or chlorhexidine can be.
IX. Preoperative skin disinfection of the incision, iodophor or chlorhexidine?
Seventeen RCTs have been conducted to investigate this issue. After a meta-analysis of these RCTs, experts found that chlorhexidine was more effective than iodophor in reducing wound infection. Therefore, chlorhexidine is highly recommended for preoperative wound disinfection.
X. Should I use antimicrobial skin sealants before surgery?
Antimicrobial sealants are usually applied preoperatively around the incision to prevent the spread of peripheral bacteria into the incision. The effectiveness of antiseptic sealants has been evaluated in nine RCTs, and Meta-analysis showed that antiseptic skin sealants did not reduce the incidence of wound infection and certainly did not produce any side effects. Considering the increased medical costs associated with antimicrobial skin sealants, experts do not recommend applying antimicrobial skin sealants preoperatively.