====== 🧴 Preoperative Skin Antisepsis ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1H_ca59kJO-Oxb-zxcwaaurU9fagtDZ7PrkkdVPIVDbyvOOEHh/?limit=15&utm_campaign=pubmed-2&fc=20250603050534}}

see [[Skin Cleaning]].
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[[Preoperative]] [[skin]] [[antisepsis]] is the process of preparing the [[surgical site]] to reduce microbial load and minimize the risk of **[[surgical site infection]]s (SSIs)**.

===== 🎯 Objectives =====
  * Eliminate transient flora
  * Reduce resident skin flora
  * Prevent introduction of microorganisms into the surgical wound

===== 🧪 Common Antiseptic Agents =====

^ Agent                          ^ Main Component         ^ Characteristics                                                  ^
| **Chlorhexidine gluconate**   | 2–4% in alcohol/aqueous| Broad-spectrum, long-lasting, binds to skin proteins             |
| **Povidone-iodine**           | 7.5–10%                | Effective vs bacteria, viruses, fungi. Inactivated by blood/serum|
| **Alcohol-based solutions**   | Ethanol or isopropyl   | Fast-acting. No residual effect unless combined with CHG/iodine  |

===== 🛠️ Procedure =====

  - **[[Hair removal]]**: Use clippers just before surgery. Avoid razors.
  - **[[Skin cleaning]]**: Wash soiled areas with soap and water.
  - **Application of [[antiseptic]]**:
    - Apply in concentric circles from inside outward.
    - Do not go back over central area.
    - Allow to dry completely (2–3 min for alcohol-based).
  - **[[Draping]]**: Only after antiseptic is dry.

===== ✅ Best Practices =====

  * Use **CHG + alcohol** (e.g., 2% CHG + 70% isopropyl alcohol) unless contraindicated.
  * Respect **contact time**:
    - CHG: ~2 minutes
    - Povidone-iodine: ~2–3 minutes
  * **Do not blot dry**.

===== ⚠️ Contraindications / Precautions =====

  * Avoid CHG on **mucosa, eyes, ears** or with allergy.
  * Alcohol-based agents are **flammable** → ensure **drying** before electrocautery.

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{{tag:preoperative antisepsis surgery skin_protocol}}

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Effective [[preoperative]] antisepsis is recognized to prevent [[surgical site infection]] (SSI), although the definitive method is unclear.

Many have compared [[chlorhexidine]] (CHG) with [[povidone-iodine solution]] (PVI), but there is emerging evidence for combination usage. Objective  To conduct a systematic review and meta-analysis to evaluate if combination skin preparation (1) reduces colonization at the operative site and (2) prevents SSI compared with single-agent use. Data Sources  A literature search of MEDLINE, Embase, and the Cochrane Database of Clinical Trials was performed. Study Selection  Comparative, human trials considering the combination use of CHG and PVI, as preoperative antisepsis, to single-agent CHG or PVI use were included. Studies were excluded from meta-analysis if the use or absence of alcohol was inconsistent between study arms. Data Extraction and Synthesis  The study was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Main Outcomes and Measures  The primary outcome of the meta-analysis was surgical site infection. The secondary outcome was colonization at the operative site. Results  Eighteen publications with a combination of CHG and PVI use were identified. Of these, 12/14 inferred promise for combination usage, including four trials eligible for meta-analysis. Only one trial reported SSI as its outcome. The remaining three considered bacterial colonization. Combination preparation had a pooled odds ratio for complete decolonization of 5.62 (95% confidence interval 3.2 to 9.7, p  < 0.00001). There was no evidence of heterogeneity (Cochran's Q 2.1, 2 df , p  = 0.35). Conclusions and Relevance  There is emerging, albeit low-quality, evidence in favor of combination CHG and PVI preoperative antisepsis. Further rigorous investigation is indicated
((Davies BM, Patel HC. Systematic Review and Meta-Analysis of Preoperative
Antisepsis with Combination Chlorhexidine and Povidone-Iodine. Surg J (N Y). 2016
Aug 10;2(3):e70-e77. doi: 10.1055/s-0036-1587691. eCollection 2016 Jul. PubMed
PMID: 28824994; PubMed Central PMCID: PMC5553484.
)).

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The antisepsis should be carried out with povidone. Afterwards, benzoin should be applied to better guarantee the area adhesivity.