title: Is surgical site scrubbing before painting of value? Review and meta-analysis of clinical studies.
abstract: BACKGROUND
  Surgical site infections are major surgical complications. Surgical site scrubbing before painting is controversial.
  
  
  OBJECTIVE
  To conduct a meta-analysis of clinical trials that compared pre-operative scrubbing before painting with painting alone for the prevention of surgical site infections.
  
  
  METHODS
  A systematic review and meta-analysis of clinical trials in Pubmed, ScienceDirect and Cochrane databases that compared pre-operative scrubbing before painting with painting alone, and reported surgical site infections, skin colonization or adverse effects as an outcome, was undertaken. A fixed-effect model and a random-effect model were tested. Sensitivity analysis was conducted by removing non-randomized controlled trials.
  
  
  RESULTS
  The systematic review identified three studies, involving 570 patients, for surgical site infection outcomes, and four other studies, involving 1082 patients, for positive skin culture outcomes. No significant differences were observed between scrubbing before painting vs painting alone in terms of surgical site infection or positive skin culture.
  
  
  CONCLUSIONS
  Further research is needed to draw conclusions. Only one study in this meta-analysis identified adverse effects, but there were too few events to compare the various methods. It is believed that there is no need to scrub the surgical site if the skin is visibly clean and/or if the patient has had a pre-operative shower.
authors.affiliation: Service d'Epidémiologie et d'Hygiène Hospitalières, CHU Dijon, France. Electronic address: annick.lefebvre@chu-dijon.fr.
authors.forename: A
authors.initials: A
authors.lastname: Lefebvre
authors.affiliation: Service de Santé Publique, Hygiène Hospitalière, Évaluation, CHU Brest, France.
authors.forename: P
authors.initials: P
authors.lastname: Saliou
authors.affiliation: Service d'Anesthésiologie-Réanimation Chirurgicale, CHU de Poitiers, France.
authors.forename: O
authors.initials: O
authors.lastname: Mimoz
authors.affiliation: UHLIN - GH Bichat - Claude Bernard, HUPNVS, AP-HP, Paris, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Lucet
authors.affiliation: Service de Chirurgie Thoracique et Cardiovasculaire et Angiologie, CHU Limoges, France.
authors.forename: A
authors.initials: A
authors.lastname: Le Guyader
authors.affiliation: Service d'Urologie, CHU Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Bruyère
authors.affiliation: Service de Neurochirurgie, CHU Nord, Marseille, France.
authors.forename: P H
authors.initials: PH
authors.lastname: Roche
authors.affiliation: Service d'Epidémiologie et d'Hygiène Hospitalières, CHU Dijon, France.
authors.forename: K
authors.initials: K
authors.lastname: Astruc
authors.affiliation: Service d'Epidémiologie et d'Hygiène Hospitalières, CHU Dijon, France.
authors.forename: M
authors.initials: M
authors.lastname: Tiv
authors.affiliation: Unité de Gestion du Risque Infectieux, Service de Bactériologie-Hygiène, CHU Nantes, France.
authors.forename: D
authors.initials: D
authors.lastname: Lepelletier
authors.affiliation: Service d'Epidémiologie et d'Hygiène Hospitalières, CHU Dijon, France.
authors.forename: L S
authors.initials: LS
authors.lastname: Aho-Glélé
mesh_terms: D004203:Disinfection / Q000379:methods*; D006801:Humans; D011300:Preoperative Care / Q000009:adverse effects* / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Meta-analysis; Pre-operative care/methods; Scrub/scrubbing; Skin/microbiology; Surgical wound infection prevention and control