Alcoholic chlorhexidine skin preparation or triclosan-coated sutures to reduce surgical site infection: a systematic review and meta-analysis of high-quality randomised controlled trials
Adesoji Ademuyiwa, Adewale Adisa, Simon P. Bach, Aneel Bhangu, Ewen M. Harrison, JC Allen Ingabire, Parvez Haque, Ismaïl Lawani, James Glasbey, Dhruva Ghosh, Bryar Kadir, Sivesh K. Kamarajah, Elizabeth Li, Rachel Lillywhite, Harvinder Mann, Janet Martin, Antonio Ramos de la Madina, Rachel Moore, Dion Morton, Dmitri Nepogodiev, Faustin Ntirenganya, Thomas Pinkney, Peter Pockney, Omar Omar, Joana Simões, Neil Smart, Donna Smith, Stephen Tabiri, Elliot Taylor, Richard Wilkin
Abstract
BACKGROUND: WHO and the UK's National Institute for Health and Care Excellence recommend alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent surgical site infections (SSIs). Existing meta-analyses that include studies at high risk of bias, combined with the recent publication of large, randomised trials, justify an updated meta-analysis of high-quality randomised controlled trials (RCTs). We aimed to test the rates of SSI according to skin preparation solutions (ie, alcoholic chlorhexidine vs aqueous povidone-iodine) and types of sutures (ie, coated vs uncoated). METHODS: statistic. This systematic review and meta-analysis was prospectively registered in PROSPERO, CRD42021267220. FINDINGS: =36·4%). INTERPRETATION: Contrary to previous meta-analyses, this study did not show a benefit from either alcoholic chlorhexidine skin preparation or triclosan-coated sutures, both of which are more expensive than other readily available alternatives. Global and national guidance should be reconsidered to remove recommendations for their routine use. FUNDING: National Institute for Health Research (NIHR) Global Health Research Unit.