title: Economic case for intraoperative interventions to prevent surgical-site infection.
abstract: BACKGROUND
  Surgical-site infection (SSI) occurs in 1-10 per cent of all patients undergoing surgery; rates can be higher depending on the type of surgery. The aim of this review was to establish whether (or not) surgical hand asepsis, intraoperative skin antisepsis and selected surgical dressings are cost-effective in SSI prevention, and to examine the quality of reporting.
  
  
  METHODS
  The authors searched MEDLINE via Ovid, CINAHL via EBSCO, Cochrane Central and Scopus databases systematically from 1990 to 2016. Included were RCTs and quasi-experimental studies published in English, evaluating the economic impact of interventions to prevent SSI relative to surgical hand and skin antisepsis, and wound dressings. Characteristics and results of included studies were extracted using a standard data collection tool. Study and reporting quality were assessed using SIGN and CHEERS checklists.
  
  
  RESULTS
  Across the three areas of SSI prevention, the combined searches identified 1214 articles. Of these, five health economic studies evaluating the cost-effectiveness of selected surgical dressings were eligible. Study authors concluded that the interventions being assessed were cost-effective, or were potentially cost-saving. Still, there is high uncertainty around the decision to adopt these dressings/devices in practice. The studies' reporting quality was reasonable; three reported at least 15 of the 24 CHEERS items appropriately. Assessment of methodological quality found that two studies were considered to be of high quality.
  
  
  CONCLUSIONS
  With few economic studies undertaken in this area, the cost-effectiveness of these strategies is unclear. Incorporating economic evaluations alongside RCTs will help towards evidence-informed decisions.
authors.affiliation: School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.|Gold Coast University Hospital and Health Service, Griffith University, Gold Coast, Australia.|National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Australia.
authors.forename: B M
authors.initials: BM
authors.lastname: Gillespie
authors.affiliation: National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Chaboyer
authors.affiliation: Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Erichsen-Andersson
authors.affiliation: Centre for Applied Health Economics, School of Medicine, Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: R M
authors.initials: RM
authors.lastname: Hettiarachchi
authors.affiliation: Centre for Applied Health Economics, School of Medicine, Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kularatna
mesh_terms: D001458:Bandages / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000191:economics; D013530:Surgical Wound Infection / Q000191:economics* / Q000517:prevention & control*