Abstract：
OBJECTIVE: While the World Health Organization has recommended preoperative washing with plain or antimicrobial soap for surgical site infection (SSI) prevention, it has not formulated recommendations on use of chlorhexidine gluconate (CHG)-impregnated cloths. The purpose of this systematic review was to evaluate the benefit of preoperative bathing with CHG-cloths on SSI incidence.
METHODS: Publications were searched on Medline, CENTRAL, Web of Science, Clinical Trial between 01/01/1990 and 30/06/2018. Randomized controlled trials (RCT), quasi-randomized, case-control and cohort studies on patients with surgery (Population) having preoperative bathing with CHG-cloths (Intervention) or antiseptic soap, plain soap, placebo, no washing, no instruction (Comparator) were included. The main outcome was SSI occurrence. The results were synthetized using the Odds-Ratio (OR) and 95% confidence interval [95%CI]. Study quality was assessed using the Cochrane and Newcastle-Ottawa tools and evidence quality with the GRADE method. Statistics were calculated on RevMan5.3.
RESULTS: All in all, 1108 publications were identified and 3 were included in the meta-analysis. OR of the 2 cohort studies was 0.25 [95%CI: 0.13-0.50] for use of CHG-cloths the evening and the morning before intervention versus non-compliance with preoperative washing. OR of the RCT was 0.12 [95%CI: 0.02-1.00] for use of CHG-cloths the evening and the morning before intervention versus a shower with antibacterial soap the evening before the intervention. Study quality was moderate.
CONCLUSIONS: While the available studies show a benefit for CHG-cloths on SSI occurrence in orthopaedic surgery, there is no comparison with usual practices. Further studies are needed to confirm the benefit of CHG-cloths for preoperative washing.
METHODS: Publications were searched on Medline, CENTRAL, Web of Science, Clinical Trial between 01/01/1990 and 30/06/2018. Randomized controlled trials (RCT), quasi-randomized, case-control and cohort studies on patients with surgery (Population) having preoperative bathing with CHG-cloths (Intervention) or antiseptic soap, plain soap, placebo, no washing, no instruction (Comparator) were included. The main outcome was SSI occurrence. The results were synthetized using the Odds-Ratio (OR) and 95% confidence interval [95%CI]. Study quality was assessed using the Cochrane and Newcastle-Ottawa tools and evidence quality with the GRADE method. Statistics were calculated on RevMan5.3.
RESULTS: All in all, 1108 publications were identified and 3 were included in the meta-analysis. OR of the 2 cohort studies was 0.25 [95%CI: 0.13-0.50] for use of CHG-cloths the evening and the morning before intervention versus non-compliance with preoperative washing. OR of the RCT was 0.12 [95%CI: 0.02-1.00] for use of CHG-cloths the evening and the morning before intervention versus a shower with antibacterial soap the evening before the intervention. Study quality was moderate.
CONCLUSIONS: While the available studies show a benefit for CHG-cloths on SSI occurrence in orthopaedic surgery, there is no comparison with usual practices. Further studies are needed to confirm the benefit of CHG-cloths for preoperative washing.
摘要：
目的：虽然世界卫生组织建议术前用普通或抗菌肥皂清洗以预防手术部位感染（SSI），它尚未就使用葡萄糖酸氯己定（CHG）浸渍的布提出建议。这项系统评价的目的是评估术前使用CHG布浴对SSI发生率的益处。
方法：在Medline上搜索出版物，中部,WebofScience,1990年1月1日至2018年6月30日之间的临床试验。随机对照试验（RCT），准随机化，术前使用CHG布（干预）或抗菌肥皂沐浴的手术患者（人群）的病例对照和队列研究，普通肥皂,安慰剂,不清洗，不包括任何指令（比较器）。主要结果为SSI发生。使用赔率比(OR)和95%置信区间[95CI]合成结果。使用Cochrane和Newcastle-Ottawa工具评估研究质量，并使用GRADE方法评估证据质量。统计数据是在RevMan5.3上计算的。
结果：总而言之，共鉴定出1108篇出版物，其中3篇纳入荟萃分析。2项队列研究的OR为0.25[95CI:0.13-0.50]，在干预前的晚上和早晨使用CHG-cloths与不遵守术前清洗。在干预前的晚上和早晨使用CHG布，而在干预前的晚上和早晨使用抗菌肥皂淋浴的RCT的OR为0.12[95CI：0.02-1.00]。研究质量适中。
结论：虽然现有研究表明CHG-cloths在骨科手术中对SSI的发生有益处，与通常的做法没有比较。需要进一步的研究来确认CHG布在术前清洗中的益处。
方法：在Medline上搜索出版物，中部,WebofScience,1990年1月1日至2018年6月30日之间的临床试验。随机对照试验（RCT），准随机化，术前使用CHG布（干预）或抗菌肥皂沐浴的手术患者（人群）的病例对照和队列研究，普通肥皂,安慰剂,不清洗，不包括任何指令（比较器）。主要结果为SSI发生。使用赔率比(OR)和95%置信区间[95CI]合成结果。使用Cochrane和Newcastle-Ottawa工具评估研究质量，并使用GRADE方法评估证据质量。统计数据是在RevMan5.3上计算的。
结果：总而言之，共鉴定出1108篇出版物，其中3篇纳入荟萃分析。2项队列研究的OR为0.25[95CI:0.13-0.50]，在干预前的晚上和早晨使用CHG-cloths与不遵守术前清洗。在干预前的晚上和早晨使用CHG布，而在干预前的晚上和早晨使用抗菌肥皂淋浴的RCT的OR为0.12[95CI：0.02-1.00]。研究质量适中。
结论：虽然现有研究表明CHG-cloths在骨科手术中对SSI的发生有益处，与通常的做法没有比较。需要进一步的研究来确认CHG布在术前清洗中的益处。
