Optimal Skin Preparation to Prevent Surgical Site Infections

Dr Trisha Peel1

 1Infectious Diseases and Antimicrobial Stewardship Physician, NHMRC ECF and Senior Research Fellow, Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia


Over 2 million surgeries are performed annually in Australia and up to 15% of these procedures are complicated by surgical site infections (SSIs). These infections are the leading cause of healthcare associated infections and are the costliest; with healthcare budget estimates of $20,000 per SSI. SSIs represent a significant burden to patients, frequently necessitating prolonged hospitalisations, repeat operations and broad-spectrum antimicrobial. The patient’s own bacterial flora is thought be the primary source of most SSIs and is the target of prevention strategies including surgical site skin preparation. Surgical site skin preparation is a simple and effective strategy to decontaminate patient’s skin prior to surgical incision. The three main agents commonly used for surgical skin antisepsis are chlohexidine gluconate, iodophors or alcohol. Alcohol is frequently combined with chlorhexidine gluconate or iodophors to optimise the activity of the surgical site skin preparation. These agents are inexpensive and are well tolerated.

Despite over a century of use, it is still unclear which agent is the optimal agent to prevent SSI. This is reflected in two recent published guidelines with conflicting recommendations. The World Health Organization (WHO) guidelines recommended alcohol-based chlorhexidine for surgical site skin preparation, based on low to moderate quality of evidence. In contrast, the Centers for Disease Control and Prevention (CDC) guidelines recommended that an alcohol-based agent be used without specifying whether chlorhexidine or iodophors should be used, based on high quality evidence.

This presentation will review the current evidence for surgical site skin preparation, including data from recent randomised controlled trials.

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