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.
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。