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Intra-Operative Surgical Irrigation of the Surgical Incision: What Does the Future HoldSaline, Antibiotic Agents, or Antiseptic Agents?

Lookup NU author(s): Professor David Leaper

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Abstract

Background: Intra-operative surgical site irrigation (lavage) is common practice in surgical procedures in general, with all disciplines advocating some form of irrigation before incision closure. This practice, however, has been neither standardized nor is there compelling evidence that it effectively reduces the risk of surgical site infection (SSI). This narrative review addresses the laboratory and clinical evidence that is available to support the practice of irrigation of the abdominal cavity and superficial/deep incisional tissues, using specific irrigation solutions at the end of an operative procedure to reduce the microbial burden at wound closure. Methods: Review of PubMed and OVID for pertinent, scientific, and clinical publications in the English language was performed. Results: Incision irrigation was found to afford a three-fold benefit: First, to hydrate the bed; second, to assist in allowing better examination of the area immediately before closure; and finally, by removing superficial and deep incisional contamination and lowering the bioburden, expedite the healing process. The clinical practice of intra-operative peritoneal lavage is highly variable and is dependent solely on surgeon preference. By contrast, intra-operative irrigation after device-related procedures has become a standard of care for the prophylaxis of acute peri-prosthetic infection. The clinical evidence that supports the use of antibiotic irrigation is limited and based on retrospective analysis and few acceptable randomized controlled trials. The results of laboratory and animal studies using aqueous 0.05% chlorhexidine gluconate are favorable, suggesting that further studies are justified to determine its clinical efficacy. Conclusion: The adoption of appropriate and standardized intra-operative irrigation practices into peri-operative care bundles, which include other evidence-based strategies (weight-based antimicrobial prophylaxis, antimicrobial sutures, maintenance of normothermia, and glycemic control), offers an inexpensive and effective method to reduce the risk of post-operative SSI and deserves further evaluation.


Publication metadata

Author(s): Edmiston CE, Leaper DJ

Publication type: Review

Publication status: Published

Journal: Surgical Infections

Year: 2016

Volume: 17

Issue: 6

Pages: 656-664

Print publication date: 01/12/2016

Online publication date: 27/09/2016

Acceptance date: 01/01/1900

ISSN (print): 1096-2964

ISSN (electronic): 1557-8674

Publisher: MARY ANN LIEBERT, INC

URL: http://dx.doi.org/10.1089/sur.2016.158

DOI: 10.1089/sur.2016.158


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