Risk Of Postoperative Wound Infection Research Articles

Effect of wound healing of orthopedic surgery in human immunodeficiency virus infected patients with perioperative adjuvant treatments

To observe the early wound healing of orthopedic surgery in human immunodeficiency virus (HIV) carrier patients treated with optimized auxiliary treatments. During a period of 48 months, according to the inclusion and exclusion criteria plus CD4⁺ T lymphocyte count, the patients scheduled for orthopedic surgery (including HIV positive and negative) were divided into group A (HIV positive, CD4<500/ml) with optimized auxiliary treatments, group B (HIV positive, CD4 ≥ 500/ml) and group C (HIV negative) on prophylactic antibiotic therapy alone. Wound healing of 3 groups were observed postoperatively. The rates of clinical wound infection were compared among 3 groups. A total of 471 cases (n = 79, HIV+; n = 392, HIV-) were selected due to fresh fracture (n = 544, 77.28%), fracture of spine (n = 57, 12.31%), mal-union (n = 13, 2.76%), aseptic necrosis (n = 15, 3.18%) and osteoarthritis (n = 21, 4.46%). During surgery, early open reduction and plate screw internal fixation (group A, n = 23; group B, n = 21; group C, n = 274); pedicle screw internal fixation (group A, n = 5; group B, n = 6; group C, n = 47); total joint replacement (group A, n = 3; group B, n = 4; group C, n = 8); interlocking intramedullary nail fixation (group A, n = 7; group B, n = 4; group C, n = 35) and other operations (group A, n = 3; group B, n = 3; group C, n = 28). For infections, 2 cases (4.88%) were observed in group A, 3 (5.26%) in group B and 26 (6.63%) in group C. The differences were statistically insignificant. Reasonable perioperative adjuvant treatments, including use of antibiotic, nutritional supports, immunomodulators and anti-retroviral drugs, are offered to HIV infected patients undergoing orthopedic surgery. Their risks of postoperative wound infection may be controlled.

PHARMACOECNOMIC USE OF 750 MG CEFUROXIME INTRAVENOUSLY FOR INGUINAL HERNIA MESH REPAIR SURGERY ASSOCIATED INFECTIONS.

Main delineative of the present study was to ascertain the effectiveness of cefuroxime prophylaxis in restraining the postoperative wound infection during scavenging inguinal hernia mesh after furbish up surgery and also to equate single day with multiple day antibiotic prophylaxis during hospital stay and for monetary appraise. 326 patients with inguinal hernia were investigated and divided into two groups with 171 patients in group A and 155 in group B. Group A was treated with three intravenous doses just half an hour before surgery followed by two more doses with 8 hours interval and oral therapy of 500 mg of cefuroxime divided into two doses. Group B received six intravenous doses and followed by same oral therapy as of group A. Total therapy was carried out uninterrupted for 4 days in both groups. The outcomes of study indicated that 4.7% and 6.45% of the patients of group A and B explicated surgical site infections respectively, while the hospital detention of group A and B was 2.15 and 3.27 days respectively. Overall, the cost effectiveness of group A was 33% more frugal than Group B. It is concluded that there was no significant differences in one day and two days prophylaxis with cefuroxime in patients with inguinal hernia mesh repair surgery relative to post-operative surgical site infection. The risk of post-operative wound infection could therefore be efficaciously be contended by one day t.i.d treatment, eventually had salutary consequences on the hospital stay and cost obligingness of patient.

Assessing the effects of sliding doors on an operating theatre climate

Surgical site infections (SSIs) are the second to third most common site of health care associated infections (HAIs). It is very important to maintain good indoor air quality (IAQ) and the best ventilation system in the operating theatre (OT) to ensure health and safety for the patient and surgical team, also to reduce the risk of post-operative wound infection. Then a significant consideration in OTs is the control of aerosols, anesthesia gases and smoke. The present paper uses the airflow modeling based on computational fluid dynamics (CFD) to study the indoor climate of a standard ISO5 class OT with an ultraclean air filter system and a total ceiling unidirectional diffuser. The OT has a heating, ventilation, and air conditioning (HVAC) plant with a laminar airflow (LAF) or ultraclean ventilation. A simple method to analyze the effects of different sliding door conditions combined with crossing persons and persons with a stretcher crossing, on the OT climate, airflow patterns and the indoor pressures scheme, is provided. The proposed simulation method, that belongs to the indirect approach for a numerical simulation of solid object movements in a fluid, provides important knowledge on complex flow phenomena combined with multi-physical conditions. Results obtained by transient simulation show disruptions of the airflow inside the OT and different airflow displacement and distribution caused by surgery staff movements and sliding door opening and closing, but in particular static pressure changes in the HVAC plant system with important effects on ventilation system working conditions and its energy performances.

Are mastoid pressure dressings necessary after otologic surgery to prevent postoperative hematomas?

Are mastoid pressure dressings necessary after otologic surgery to prevent postoperative hematomas?

Risk Factors for Postoperative Wound Infections of Sacral Chordoma After Surgical Excision

A retrospective study, analyzing the risk factors for postoperative wound infections of the sacral chordoma after surgical excision. To determine the preoperative, intraoperative, and patient characteristics that contribute to an increased risk of postoperative wound infection in patients undergoing sacral chordoma resection. Postoperative wound infection after spinal operations is a dreaded complication. The risk factors have been investigated earlier, but the patients with sacral chordoma may be distinct. Between January 1992 and December 2007, 45 patients with sacral chordomas were treated with surgical resection. Data regarding preoperative and intraoperative risk factors for postoperative wound infection were evaluated using univariate analysis and multivariable conditional logistic regression. Odds ratios with 95% confidence intervals and P values were calculated. Of the 45 patients with sacral chordoma, 16 (35.6%) acquired postoperative wound infection. Significant risk factors associated with postoperative wound infection in the univariate analysis included the following: albumin <3.0, previous surgery, operating time, instrumentation, and surgical team. Albumin<3.0, operating time >6 hours, and previous surgery were statistically significant in the multivariable model. Patients undergoing sacral tumor surgery may be at greater risk for developing wound complications. In this study, it seems that albumin<3.0, operating time >6 hours, and previous surgery may predict those patients that were more prone to developing postoperative wound infection. Using a single surgical team and no instrumentation seems to provide protection against postoperative wound infection in this patient population.

Effectiveness of Postoperative Antibiotics in Orthognathic Surgery: A Meta-Analysis

To conduct a systematic review of published clinical trials on the effectiveness of extended postoperative antibiotics in orthognathic surgery. Electronic databases were searched for randomized clinical trials. Data from relevant articles were extracted and assessed. The primary outcome variable was surgical site infection. Extracted data were analyzed using a meta-analytical program with a random effects model. In total 532 patients were assessed in 8 clinical trials. Wound infection occurred in 30 of 268 patients in the short-term prophylaxis group (frequency, 11.2%) and in 10 of 264 patients in the extended-term group (frequency, 3.8%). Extended antibiotic therapy was more effective in decreasing the risk of postoperative wound infection (odds ratio, 3.2; number needed to treat, 13.5). Extended postoperative antibiotic treatment does have a place in decreasing the risk of postoperative wound infection in orthognathic surgery. More trials are needed to standardize a proper regimen.

CO2 insufflation influences the temperature of the open surgical wound

In open surgery, heat is lost due to radiation and evaporation through the wound. Hypothermia causes tissue hypoxia and impairs various cellular immune functions that increases the risk for postoperative wound infections and delayed wound healing. The patient's body is usually well protected with heating arrangements, but the open wound is left unprotected and until now no practical method has been available to protect it thermically. We therefore investigated if insufflation of an open surgical wound with carbon dioxide would affect wound temperature. In 10 patients undergoing cardiac surgery, the sternotomy wound was insufflated with dry, room temperature carbon dioxide via a gas diffuser for 2 minutes. A heat-sensitive camera measured the wound temperature before, during, and after insufflation. Exposure to carbon dioxide increased the median temperature of the whole wound by 0.5 degrees C (p=0.01). The temperature of the area distant to the diffuser increased by 1.2 degrees C (p<0.01) whereas in the area close to the diffuser it decreased by 1.8 degrees C (p<0.01). In conclusion, short-term insufflation of dry room temperature carbon dioxide in an open wound increases the surface temperature significantly. Although a small increase, it may reduce the incidence of postoperative wound infections in the future.

Pattern of surgical antibiotic prophylaxis in a tertiary care teaching hospital in India

Appropriate antibiotic prophylaxis can reduce the risk of postoperative wound infections, but misuse and overuse of antimicrobials increases both the cost and the selection pressure favoring the emergence of resistant bacteria. Our main objective was to study the pattern of prophylactic antibiotics in different surgeries in a large tertiary care teaching hospital. A total of hundred patients undergoing surgery, admitted under various hospital departments were enrolled in this prospective observational study. Pretested proforma which included information on patient characteristics, choice of antimicrobial agents as well as their route, timing and total duration of administration were completed. Also the appropriateness of antibiotic prophylaxis was assessed as per standard guidelines. It was found that the third generation cephalosporins were the most commonly prescribed class of antibiotics. Although only 67 percent cases required prophylaxis, it was administered in 86 percent of procedures, being unjustified in 19 % of cases. Mean timing of administration of antibiotics was 3.22 ± 1.03 hours prior to surgery and the patients received post operative antibiotics for a mean duration of 5 days during their stay in the hospital. Thus, surgical prophylaxis was inappropriate in terms of choice of agent, timing of administration as well as the total duration of prescription in majority of the cases. Interventions are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial prophylaxis.

Contributory Factors to Postoperative Spinal Fusion Complications for Children With Myelomeningocele

This is a retrospective review of all children with myelomeningocele (MMC) who were undergoing surgery for scoliosis at our institution. Our aim was to investigate possible correlations between poor nutritional indexes and/or positive urinary cultures before surgery to perioperative infection risk. Patients who have scoliosis secondary to MMC have been shown to have a high rate of infectious complications. Many children with MMC have been found to have asymptomatic urinary tact infections due to their neurogenic bladder. There is little literature on risk factors for and ways to prevent postoperative infections for these patients. We reviewed a comprehensive database for the outcome for spinal fusion surgeries of 59 patients with MMC treated at our institution over the past 45 years. Perioperative infections were correlated to preoperative nutritional status (measured by patient hematocrit [Hct]) and presence of active infection using Fisher Exact Probability Test. A total of 84 different spinal fusion operations for 59 patients were recorded. Patients presenting with poor preoperative nutrition (Hct<or=33) and positive preoperative urinary cultures demonstrated the highest risk for perioperative wound infection (P=0.001). Patients with preoperative poor nutrition without a positive urinary culture as well as those with adequate nutritional status but a preoperative positive urinary culture showed an increased risk of wound infection respectively (P=0.03) and (P=0.002). Positive urine cultures obtained before spinal surgery for children with MMC significantly increased the risk for perioperative wound (P=0.002). Urinary tract infections can be easily detected and treated. We believe urinary culture, protein deficiencies, or Hct<or=33, should be treated and corrected before surgery.

2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery

It is claimed that wound closure with 2-octyl-cyanoacrylate has the advantages that band-aids are not needed in the postoperative period, that the wound can get in contact with water and that removal of stitches is not required. This would substantially enhance patient comfort, especially in times of reduced in-hospital stays. Postoperative wound infection is a well-known complication in spinal surgery. The reported infection rates range between 0% and 12.7%. The question arises if the advantages of wound closure with 2-octyl-cyanoacrylate in spinal surgery are not surpassed by an increase in infection rate. This study has been conducted to identify the infection rate of spinal surgery if wound closure was done with 2-octyl-cyanoacrylate. A total of 235 patients with one- or two-level surgery at the cervical or lumbar spine were included in this prospective study. Their pre- and postoperative course was evaluated. Analysis included age, sex, body mass index, duration and level of operation, blood examinations, 6-week follow-up and analysis of preoperative risk factors. The data were compared to infection rates of similar surgeries found in a literature research and to a historical group of 503 patients who underwent wound closure with standard skin sutures after spine surgery. With the use of 2-octyl-cyanoacrylate, only one patient suffered from postoperative wound infection which accounts for a total infection rate of 0.43%. In the literature addressing infection rate after spine surgery, an average rate of 3.2% is reported. Infection rate was 2.2% in the historical control group. No risk factor could be identified which limited the usage of 2-octyl-cyanoacrylate. 2-Octyl-cyanoacrylate provides sufficient wound closure in spinal surgery and is associated with a low risk of postoperative wound infection.

Postoperative Infection Rates in Foot and Ankle Surgery

Patients with diabetes mellitus may be at increased risk for infection following foot and ankle surgery. This study aimed to determine whether patients with a diagnosis of diabetes mellitus have an increased rate of infection following foot and ankle surgery compared with a cohort of patients without diabetes. Furthermore, our study sought to demonstrate whether patients with complicated diabetes are at greater risk of postoperative wound infection than are patients with uncomplicated diabetes or patients without diabetes. We conducted a retrospective review of the charts of 1000 patients who had orthopaedic foot and ankle surgery. The following data were extracted: patient age, sex, history of diabetes mellitus, development of postoperative infection, severity of infection, inpatient or outpatient surgery, use of internal or external fixation, tobacco use, history of organ transplantation, history of rheumatoid arthritis, length of surgery, follow-up time in weeks, and comorbid conditions. The overall infection rate in this study was 4.8%. Fifty-two percent of all infections occurred in our diabetic study group, which represented only 19% of the patient population. Postoperative infections occurred in significantly more persons with diabetes (13.2%) than in those without diabetes (2.8%). Diabetic patients were five times more likely to experience a severe infection requiring hospitalization compared with patients without diabetes. After removing the patients with neuropathy from the analysis, there was no longer a significant association between diabetes and infection. The presence of complicated diabetes increased the risk of postoperative infection by a factor of ten compared with the risk for patients without diabetes and by a factor of six compared with the risk for patients with uncomplicated diabetes. We did not identify a significantly increased risk of infection in patients with uncomplicated diabetes compared with that in patients without diabetes. Patients with diabetes mellitus are at increased risk of severe infection compared with those without diabetes. Patients with uncomplicated diabetes did not have an increased risk of postoperative infection compared with patients without diabetes, whereas patients with complicated diabetes had a significantly higher rate of postoperative infection.

Poster 18: Oral Health Care Reduces the Risk of Postoperative Wound Infection in Patients With Oral Squamous Cell Carcinoma

Statement of the Problem: Postoperative wound infection (WI) is a main complication after head and neck surgery. WI may lead to significant morbidity, poor cosmetic results, delayed wound healing, prolonged hospitalization, and delay postoperative cancer treatment. Poor oral health is one of the risk factors for WI. Oral health care reduces the number of microorganisms in the oral cavity. To our knowledge, it has not been clarified whether oral health care would lower the risk of postoperative WI in patients with oral squamous cell carcinoma (OSCC).

Risk Factors for Postoperative Spinal Wound Infections After Spinal Decompression and Fusion Surgeries

This is a multivariate analysis of a prospectively collected database. To determine preoperative, intraoperative, and patient characteristics that contribute to an increased risk of postoperative wound infection in patients undergoing spinal surgery. Current literature sites a postoperative infection rate of approximately 4%; however, few have completed multivariate analysis to determine factors which contribute to risk of infection. Our study identified patients who underwent a spinal decompression and fusion between 1997 and 2006 from the Veterans Affairs' National Surgical Quality Improvement Program database. Multivariate logistic regression analysis was used to determine the effect of various preoperative variables on postoperative infection. Data on 24,774 patients were analyzed. Wound infection was present in 752 (3.04%) patients, 287 (1.16%) deep, and 468 (1.89%) superficial. Postoperative infection was associated with longer hospital stay (7.12 vs. 4.20 days), higher 30-day mortality (1.06% vs. 0.5%), higher complication rates (1.24% vs. 0.05%), and higher return to the operating room rates (37% vs. 2.45%). Multivariate logistic regression identified insulin dependent diabetes (odds ratios [OR] = 1.50), current smoking (OR = 1.19) ASA class of 3 (OR = 1.45) or 4 to 5 (OR = 1.66), weight loss (OR = 2.14), dependent functional status (1.36) preoperative HCT <36 (1.37), disseminated cancer (1.83), fusion (OR = 1.24) and an operative duration of 3 to 6 hours (OR = 1.33) or >6 hours (OR = 1.40) as statistically significant predictors of postoperative infection. Using multivariate analysis of a large prospectively collected data from the National Surgical Quality Improvement Program database, we identified the most important risk factors for increased postoperative spinal wound infection. We have demonstrated the high mortality, morbidity, and hospitalization costs associated with postoperative spinal wound infections. The information provided should help alert clinicians to presence of these risks factors and the likelihood of higher postoperative infections and morbidity in spinal surgery patients.

Comparison of the Effectiveness of Painting onto the Hand and Immersing the Hand in a Bag, in Pre-Operative Skin Preparation of the Hand

The main goal of pre-operative skin preparation is to reduce the risk of postoperative wound infections by removing transient and commensal organisms from the skin. The aim of this study was to compare two methods of application of antiseptic solution in their effectiveness in removing these organisms from the skin. Fifty volunteers participated in the study. In 25 patients, the left hand was prepared using a standard paint technique and the right hand using the bag technique; in the other 25 the right was painted and the left was prepared using the bag technique. Three areas of the hand were examined: the paronychium of the thumb, the second web space and the hyponychium of the middle finger. Bacterial cultures were assessed after 5 days for growth. The bag technique proved better at removing organisms from the skin when comparing each site, and when comparing the total number of colony forming units (P = 0.002 for the thumb, P = 0.013 for the second web space and P = 0.003 for the middle finger). We concluded that pre-operative application of povidoneiodine to a hand using a non-sterile bag technique is more effective in removing skin organisms than the standard paint technique.

Outcome following axillary staging in early breast cancer

543 Background: Sentinel lymph node biopsy (SLNB) has evolved as the standard of care for early-stage breast cancer. The benefits of SLNB are accurate staging with minimal morbidity when compared to axillary lymph node dissection (ALND). The aim of this study was to systematically appraise the outcome of SLNB when compared to conventional ALND. Methods: A comprehensive search for published trials which examined outcomes after SLNB for invasive breast cancer was performed using medline and cross referencing available data. Reviews of each study were conducted and data were extracted. Fixed and random effects methods were used to combine data. Primary outcomes were nodal positivity and surgery related morbidity. Results: Analysis of 2,659 patients from randomized trials demonstrates that the overall rate of positive axillary lymph nodes for those with clinically negative nodes was 27.1% for ALND and 30.9 % for SLNB (RR 1.09, CI 0.94–1.27, P>0.05). Patients who undergo SLNB are significantly less likely to suffer postoperative morbidity (RR 0.415, 95% CI= 0.28–0.62, p<0.05). The risk of postoperative wound infection (RR 0.61, 95% CI= 0.45–0.82, P=0.0011) and seroma (RR 0.5, 95% CI=0.35- 0.7, p<0.0001) are reduced in patients undergoing SLNB relative to ALND. The risk of arm swelling (RR 0.29, 95% CI= 0.21–0.39, P<0.0001) and paresthesia (RR 0.47, 95% CI=0.41–0.54, p<0.0001) at 6 months are also reduced in those undergoing SLNB. Conclusions: This meta-analysis confirms that SLNB is the optimum approach in terms of morbidity for the assessment of axillary metastasis in early, clinically node-negative breast cancer. These results confirm that SLNB is at least as good as ALND in detecting metastatic disease. No significant financial relationships to disclose.

Antibiotic Prophylaxis: Current Recommendations

Antibiotic prophylaxis consists of a brief course of antibiotics initiated preoperatively in order to decrease the risk of postoperative wound infection in the patient with a clean wound. The antibiotic should be started within 60 minutes before skin incision and continued for not more than 24 hours. Antibiotic therapy is indicated for the contaminated or dirty wound. In open fractures, antibiotics should be started as soon as possible after injury and continued for 3 days (type I and II fractures) or 5 days (type III). This treatment should be combined with local therapy consisting of antibiotic-impregnated polymethylmethacrylate beads. Although the utility of antibiotics in low-velocity gunshot wounds is controversial, high-velocity gunshot wounds should be treated with 48 to 72 hours of antibiotic therapy.

Spectrum of Spine Infections in Patients with HIV

Because of the increase in patients with human immunodeficiency virus, practitioners are likely to see a concordant increase of infections. Spontaneous spinal infections can result from a variety of organisms. A common pathogen is Staphylococcus aureus, which is the most frequent cause of pyogenic spinal infection in patients who test positive for the human immunodeficiency virus. Human immunodeficiency virus has caused a resurgence of spinal tuberculosis and other infections. The pandemic of human immunodeficiency virus has caused a rise in extremely rare spinal infections caused by fungus, virus, and atypical bacteria that usually are nonpathogenic. As the number of elective and emergent spinal surgeries become more frequent, spinal practitioners also must become more familiar with the particularities of preoperative and perioperative decision making. Patients' CD4 cell counts are a useful preoperative parameter to stratify the risk for postoperative wound infection because counts less than 200/mm3 seem to be a critical threshold. A case of a patient with the human immunodeficiency virus is presented. The patient had a chronic, postoperative infection and posttraumatic post-laminectomy kyphosis; he was successfully treated with staged procedures including debridement, deformity correction, stabilization, and appropriate antibiotic therapy. Level V (expert opinion). Please see the Guidelines for Authors for a complete description of levels of evidence.

Comparison of Bariatric and Non-Bariatric Elective Operations in Morbidly Obese Patients on the Basis of Wound Infection

Wound infection rates after various types of bariatric operations have been well described. The question of whether bariatric surgery increases wound infection rate compared with similar elective surgical procedures in obese patients has not been clearly answered. The purpose of this study was to investigate wound status of morbidly obese patients after elective general surgery. A prospective evaluation was conducted of 141 morbidly obese patients undergoing bariatric (n=60) and non-bariatric elective general surgery operation of similar invasiveness (n=81) with the ASEPSIS wound surveillance method. Median age of patients undergoing non-bariatric elective surgery (51, 32-68) was significantly higher than patients exposed to bariatric surgery (39, 24-57). Patients undergoing bariatric surgery had higher BMIs (44.0, 35-52.5) compared to the others (38.4, 35-43). All patients enrolled in the study were followed for a 21-day period. At the 7th postoperative day, 9 patients in the bariatric surgery group developed infection (15%), whereas 13 patients (16%) in the non-bariatric surgery group suffered wound infection. Wound infection was still present in 2 patients (3.4%) in the bariatric surgery group and 3 patients (3.7%) in the non-bariatric surgery group at the 21st day. Risk factors for wound infection included history of coronary artery diseases, diabetes, chronic respiratory illness and malignant disease. Bariatric surgery does not cause an additional risk of postoperative wound infection in morbidly obese patients, compared to elective general surgical operations of the same invasiveness.

Influence of obesity on in-hospital and early mortality and morbidity after myocardial revascularization.

Obese patients are thought to have an increased risk for complications in coronary artery bypass surgery. Several risk stratification systems do not identify obesity as a variable for risk adjustment. The aim of this study is to evaluate the in-hospital and early (one year) mortality and morbidity in obese and non-obese patients after a CABG in the UMC St Radboud. The data of 1130 patients undergoing a myocardial revascularization from January 2000 to August 2002 were analyzed. Obesity was measured by the body mass index (BMI). A BMI>or=30 kg/m2 was defined as obese. We compared 206 obese patients with 924 non-obese patients. Uni- and multivariate analysis were used to analyze the results. The 1-year survival was analyzed using Kaplan-Meier methods. There were no significant differences between obese and non-obese patients according to postoperative myocardial infarction, re-operation for bleeding, in-hospital mortality, renal complications, neurological complications, pulmonary complications, gastrointestinal complications, re-intubation, re-admission on intensive care, ventilation time, days on intensive care, days in hospital and late mortality. Only the incidence of postoperative wound infections was increased in obese patients, 8.3% in the obese versus 4.4% in the non-obese (P=0.02). Multivariate analysis identified obesity only as risk factor for postoperative for wound infections (P=0.04, odds ratio: 1.97). Obese patients do not have an increased risk of in-hospital and early (1 year) mortality after CABG. However, obese patients have an increased risk of postoperative wound infections compared to non-obese patients.

Preoperative skin antiseptics for preventing surgical wound infections after clean surgery.

Approximately 15% of elective surgery patients and 30% of patients receiving contaminated or dirty surgery are estimated to develop post-operative wound infections. The costs of surgical wound infection can be considerable in financial as well as social terms. Preoperative skin antisepsis is performed to reduce the risk of post-operative wound infections by removing soil and transient organisms from the skin. Antiseptics are thought to be both toxic to bacteria and aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however it is unclear whether preoperative skin antisepsis actually reduces post-operative wound infection and if so which antiseptic is most effective. To determine whether preoperative skin antisepsis reduces post-operative surgical wound infection. We searched the Cochrane Wounds Group Specialised Trials Register and the Cochrane Central Register of Controlled Trials in April 2004. In addition we handsearched journals, conference proceedings and bibliographies. Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There were no restrictions based on language, date or publication status. Three reviewers independently undertook data extraction and assessment of study quality. Pooling was inappropriate and trials are discussed in a narrative review. We identified six eligible RCTs evaluating preoperative antiseptics. There was significant heterogeneity in the comparisons and the results could not be pooled. In one study, infection rates were significantly lower when skin was prepared using chlorhexidine compared with iodine. There was no evidence of a benefit in four trials associated with the use of iodophor impregnated drapes. There is insufficient research examining the effects of preoperative skin antiseptics to allow conclusions to be drawn regarding their effects on post-operative surgical wound infections. Further research is needed.