The reference management software EndNote X9 (Clarivate, Philadelphia, Pennsylvania) was used to import references from searched databases, remove duplicate references, screen by title and abstract, retrieve and screen full text documents, and record reasons for exclusions. The complete search strategy used can be found in the supplementary material S1. Retrieval strategy was a combination of keywords, free words, and subject words to include multiple animal species, methods, and endpoints. Additional searches were performed for gray literature with Google Scholar, Proquest Dissertation and Theses Global, and hand searching of reference lists and book chapters. The MEDLINE/Pubmed, Web of Science Core Collection and CAB Abstracts databases were searched, with University of Bern institutional access, for published veterinary literature comparing chlorhexidine and povidone‐iodine based protocols for preoperative skin asepsis. We therefore, hypothesized that preoperative skin preparation with chlorhexidine‐based protocols would be superior to that of povidone‐iodine in both prevention of SSI and reduction of skin bacterial colonization.Ī comprehensive literature search was carried out on February 4, 2021. Considering the relationship between skin bacterial flora and SSI, and the aim of skin asepsis being reduction of skin flora, the evaluation of the reduction of both is necessary. As the choice of antiseptic should be based on the best available empirical data, including efficacy, patient tolerance and resistance development, or its potential, the objective of this study was to provide a systematic meta‐analytic assessment of the efficacy of preoperative skin asepsis protocols using chlorhexidine versus povidone‐iodine for SSI prevention and skin bacterial burden reduction in veterinary surgery. Nevertheless, criticism has arisen regarding metanalyses promoting the use of chlorhexidine‐alcohol over povidone‐iodine with or without alcohol in preventing SSI because of inclusion of studies with unknown active ingredient concentrations or concentrations below the active range.ĭespite some evidence in favor of chlorhexidine, this may not apply to veterinary surgery where patients present with different skin characteristics and microflora than human patients. Multiple veterinary studies have comparatively investigated SSI occurrence and/or bacterial reduction at the surgical site using chlorhexidine and povidone‐iodine based protocols but were unable to draw conclusions about which surgical site antiseptic should be preferred.Īccording to recent systematic reviews in human patients, chlorhexidine appears superior to povidone‐iodine in preventing SSI, with up to 30% reduction in its incidence, and in reducing skin bacterial colonization. Moreover, a longer residual effect and a greater skin tolerance have historically been attributed to chlorhexidine, characteristics that may have been overestimated. Despite chlorhexidine's wider range of antimicrobial activity compared to povidone‐iodine, concerns may arise with its use, as methicillin‐resistant Staphylococcus aureus (MRSA) and enterococci may develop acquired resistance to it. They typically involve the use of an aqueous or alcohol‐based preparation of chlorhexidine or povidone‐iodine. Aseptic protocols in veterinary surgery are traditionally based on methods used in humans. Hence, preoperative surgical site skin asepsis using appropriate products represents one of the most critical factors for SSI prevention. Preoperative surgical site asepsis practice is based on the knowledge that pathogens leading to SSI are often acquired from the patient's endogenous flora. Postoperative surgical site infection (SSI) is a leading cause of morbidity and mortality and represents a major economic and welfare burden in veterinary surgery.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |