Surgical wound irrigation: a call for evidence-based standardization of practice.
Surgical wound irrigation has long been debated as a potentially critical intraoperative measure taken to prevent the development of surgical site infection (SSI). Unlike many other SSI prevention efforts, there are no official practice guidelines or recommendations from any major medical group for the practice of surgical irrigation. As a result, practitioner implementation of the 3 major irrigation variables (delivery method, volume, and solution additives) can differ significantly. A focus group of key thought leaders in infection prevention and epidemiology convened recently to address the implications of different surgical irrigation practices. They identified an urgent need for well-designed clinical trials investigating surgical irrigation practices, improved collaboration between surgical personnel and infection preventionists, and examination of existing evidence to standardize irrigation practices. The group agreed that current published data are sufficient to support the elimination of antibiotic solutions for surgical irrigation; the avoidance of surfactants for surgical irrigation; and the use of sterile normal saline, sterile water, and 1 medical device containing a sterile 0.05% chlorhexidine gluconate solution followed by sterile saline. Given the current lack of sufficient evidence identifying ideal delivery method and volume choices, expert opinion must be relied on to guide best practice.
Infection Prevention and Control, Quality and Safety Department, Program Office, Kaiser Permanente, Oakland, CA.
Sue
S
Barnes
UHS of Delaware, a subsidiary of Universal Health Services, King of Prussia, PA.
Maureen
M
Spencer
DDG Associates, Alexandria, VA.
Denise
D
Graham
Independent medical writer, Vero Beach, FL. Electronic address: HBoehm705@aol.com.
Helen Boehm
HB
Johnson
D002986:Clinical Trials as Topic; D006801:Humans; D013530:Surgical Wound Infection / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods* / Q000592:standards*; D014947:Wounds and Injuries / Q000628:therapy*
Infection control; Infection prevention; Surgical irrigation; Surgical site infection