title: Preoperative bathing of the surgical site with chlorhexidine for infection prevention: Systematic review with meta-analysis.
abstract: BACKGROUND
  Preoperative bathing with 4% chlorhexidine is recommended as a measure to prevent surgical site infection (SSI) despite uncertainty regarding the effectiveness of the intervention. This review aimed to assess the effect of bathing with 4% chlorhexidine on the prevention of SSIs in clean surgeries compared with bathing with placebo solution or soap.
  
  
  METHODS
  Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and the Cochrane manual were followed. Sources were MEDLINE and Latin American and Caribbean Health Sciences Literature databases and manual search of references from evaluated studies. We included randomized studies evaluating clean surgical wounds and reporting SSIs after preoperative bathing with 4% chlorhexidine.
  
  
  RESULTS
  A total of 243 primary studies were identified and 8 were considered methodologically appropriate based on the Jadad Scale. Data were gathered from 10,655 patients. The global SSI rate was 7.2%. The SSI rate for chlorhexidine bathing, placebo, and soap without antiseptic groups was 7.1%, 9.1%, and 5.1%, respectively. A significant reduction in the infection rates was not found in the comparison between patients subjected to preoperative bathing with 4% chlorhexidine versus placebo solution (relative risk, 0.91; 95% confidence interval, 0.76-1.09). The same absence of benefit was observed comparing chlorhexidine bathing with soap (relative risk, 1.06; 95% confidence interval, 0.68-1.66).
  
  
  CONCLUSIONS
  Controlled clinical trials are needed to assess the effect of preoperative chlorhexidine bathing on infection rates following clean surgery before the incorporation of this intervention in health care services.
authors.affiliation: Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Electronic address: luciamcf@terra.com.br.
authors.forename: Lúcia Maciel de Castro
authors.initials: LM
authors.lastname: Franco
authors.affiliation: Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Gláucia Fernandes
authors.initials: GF
authors.lastname: Cota
authors.affiliation: Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Tatiana Saraiva
authors.initials: TS
authors.lastname: Pinto
authors.affiliation: Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Flávia Falci
authors.initials: FF
authors.lastname: Ercole
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001494:Baths / Q000379:methods*; D002710:Chlorhexidine / Q000008:administration & dosage*; D004203:Disinfection / Q000379:methods*; D006801:Humans; D015994:Incidence; D010919:Placebos / Q000008:administration & dosage; D011300:Preoperative Care / Q000379:methods*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D010919:Placebos; D002710:Chlorhexidine
keywords: Baths; Perioperative care; Surgical wound infection