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Systematic literature review on surgical site preparation in paediatric surgery.

Bielicki, I; Subotic, U; Bielicki, JA (2022) Systematic literature review on surgical site preparation in paediatric surgery. BMC Pediatr, 22 (1). p. 455. ISSN 1471-2431 https://doi.org/10.1186/s12887-022-03502-z
SGUL Authors: Bielicki, Julia Anna

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Abstract

BACKGROUND: Surgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in every surgical procedure. The most commonly used antiseptic agents for surgical skin preparation are chlorhexidine gluconate and iodophors in alcohol-based solutions. In adult patients the use of chlorhexidine-containing antiseptic solutions for preoperative skin preparation has been advocated to reduce SSI rates. Our objective was to conduct a systematic literature review on use of antiseptic agents for surgical skin preparation in children less than 16 years of age. METHODS: A systematic review of MEDLINE, EMBASE, CINAHL and CENTRAL was performed using both MeSH and free text terms and using the relevant Cochrane filter to identify full text randomized trials (RCTs) and comparative observational studies. Interventions of interest were the choice of main agent in antiseptic solutions (chlorhexidine/povidone-iodine/alcohol) compared with each other or with other antiseptic agents. Primary outcome was the reported rate of surgical site infections. RESULTS: In total 8 studies were included in the review; 2 RCTs and 6 observational studies. Observational studies generally did not primarily investigate the association of different antiseptics with subsequent SSI. The identified randomised controlled trials included only 61 children in total, and were of low quality. Consequently, we did not conduct a formal meta-analysis. Since the publication of a comprehensive systematic review of perioperative measures for the prevention of SSI in 2016, no randomized controlled trials comparing antiseptic agents for surgical skin preparation in paediatric surgery have been conducted. CONCLUSION: Robust evidence on the optimal skin antisepsis to reduce SSIs in children is lacking. Direct extrapolation of effects from trials involving adults is not appropriate as physiologic characteristics and risk factors for SSIs differ between adults and children. It is therefore essential to conduct high quality RCT investigating interventions to identify optimal measures to reduce SSI rates in children. TRIAL REGISTRATION: Prospero registration ( CRD42020166193 ).

Item Type: Article
Additional Information: © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Keywords: Anti-infective agents, local/therapeutic use, Child, Review, Surgical wound infection/prevention & control, Systematic review, Adult, Anti-Infective Agents, Local, Child, Chlorhexidine, Humans, Povidone-Iodine, Preoperative Care, Surgical Wound Infection, Humans, Surgical Wound Infection, Chlorhexidine, Povidone-Iodine, Anti-Infective Agents, Local, Preoperative Care, Adult, Child, 1114 Paediatrics and Reproductive Medicine, Pediatrics
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: BMC Pediatr
ISSN: 1471-2431
Language: eng
Dates:
DateEvent
28 July 2022Published
14 July 2022Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 35902844
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/114626
Publisher's version: https://doi.org/10.1186/s12887-022-03502-z

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