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Cochrane Database of Systematic Reviews

Use of plastic adhesive drapes during surgery for preventing surgical site infection

Información

DOI:
https://doi.org/10.1002/14651858.CD006353.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 22 abril 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Heridas

Copyright:
  1. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Joan Webster

    Correspondencia a: National Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

    [email protected]

    [email protected]

    School of Nursing and Midwifery, The University of Queensland, Brisbane, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Australia

  • Abdullah Alghamdi

    Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada

Contributions of authors

JW co‐wrote the protocol, the 'Results' and 'Discussion' sections of the review, and identified studies from the search, independently extracted data and judged the quality of studies. JW contacted the trial authors and drape manufacturers, performed the meta‐analysis and wrote the 'Description of Studies', 'Methodological Quality' and 'Reviewers Conclusions' sections of the review, and constructed the 'Tables of Comparisons'. JW coordinated the review update, performed the writing and editing of the review update, completed the drafts of the update, made an intellectual contribution, performed previous work that was the foundation of the current update and wrote to study authors, experts and companies.

AA co‐wrote the protocol, the 'Results' and 'Discussion' sections of the review, and identified studies from the search, independently extracted data and judged the quality of studies. AA also approved the review update prior to submission.

Contributions of editorial base:

Nicky Cullum: edited the review, advised on methodology, interpretation and review content. Approved the final review and first review update prior to submission.
Sally Bell‐Syer: coordinated the editorial process. Advised on methodology, interpretation and content. Edited and the review and the updates of the review.
Rocio Rodriguez‐Lopez: ran the searches for the update.

Sources of support

Internal sources

  • School of Nursing and Midwifery, Queensland University of Technology, Queensland, Australia.

  • School of Nursing and Midwifery, Griffith University, Brisbane, Australia.

External sources

  • NIHR/Department of Health (England), (Cochrane Wounds Group), UK.

Declarations of interest

Joan Webster: none known.
Abdullah Alghamdi: none known.

Acknowledgements

The authors would like to acknowledge the contribution of the Wounds Group Editors: Nicky Cullum, Andrea Nelson and David Margolis; the Trials Search Co‐ordinator Ruth Foxlee for assistance with the search strategy; Gill Worthy the Statistical Editor; referees Allyson Lipp, Jac Dines and Durhane Wong‐Rieger; and the copy editors, Elizabeth Royle and Clare Dooley for their valuable suggestions. Thanks also to Sally Bell‐Syer for her advice, for being always available and keeping the process moving so efficiently.

Version history

Published

Title

Stage

Authors

Version

2015 Apr 22

Use of plastic adhesive drapes during surgery for preventing surgical site infection

Review

Joan Webster, Abdullah Alghamdi

https://doi.org/10.1002/14651858.CD006353.pub4

2013 Jan 31

Use of plastic adhesive drapes during surgery for preventing surgical site infection

Review

Joan Webster, Abdullah Alghamdi

https://doi.org/10.1002/14651858.CD006353.pub3

2007 Oct 17

Use of plastic adhesive drapes during surgery for preventing surgical site infection

Review

Joan Webster, Abdullah Alghamdi

https://doi.org/10.1002/14651858.CD006353.pub2

2007 Jan 24

Use of plastic adhesive drapes during surgery for preventing surgical site infection

Protocol

Joan Webster, A Alghamdi A, Stephen Born, Abdullah Alghamdi

https://doi.org/10.1002/14651858.CD006353

Differences between protocol and review

The only subgroup analysis that was possible, based on available data, was of clean compared with contaminated surgery. Nor was it possible to undertake a planned sensitivity analysis based on the type of material the drape was made from due to insufficient detail about the products.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 1 Surgical site infection (all wound classifications).
Figuras y tablas -
Analysis 1.1

Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 1 Surgical site infection (all wound classifications).

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Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 2 Surgical site infection (by wound classification).
Figuras y tablas -
Analysis 1.2

Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 2 Surgical site infection (by wound classification).

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Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 3 Length of hospital stay.
Figuras y tablas -
Analysis 1.3

Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 3 Length of hospital stay.

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Comparison 2 Iodine‐impregnated adhesive drapes versus no adhesive drapes, Outcome 1 Surgical site infection.
Figuras y tablas -
Analysis 2.1

Comparison 2 Iodine‐impregnated adhesive drapes versus no adhesive drapes, Outcome 1 Surgical site infection.

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Adhesive drapes compared with no adhesive drapes for preventing surgical site infection

Patient or population: Patients undergoing surgery
Settings: Hospital
Intervention: Adhesive drapes

Comparison: No adhesive drapes

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Adhesive drapes versus no adhesive drapes

Surgical site infection (all wound classifications)
Inspection of the wound1
(follow‐up: 5 to 24 weeks2)

Medium risk population

RR 1.23
(1.02 to 1.48)

3082
(5)

⊕⊕⊕⊕
High3,4

109 per 1000

134 per 1000
(111 to 161)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Various definitions of infection were used; we accepted the authors definition in each case.
2 In one trial (Psaila 1977) the follow‐up period was not nominated.
3 Generation of random allocation sequence was unclear in two trials (Chiu 1993; Psaila 1977). Allocation concealment was unclear in four trials (Chiu 1993; Cordtz 1989; Jackson 1971; Psaila 1977). Outcome assessment was blinded in only one of the five studies (Ward 2001). However, although information about these quality issues were not available for some trials, results were similar across trials so we do not believe results were compromised by these omissions in reporting.
4 The total sample met requirements for optimal information size, and the total number of events exceeded 300.

Figuras y tablas -
Ir a la tabla de la revisión

Iodophore‐impregnated adhesive drapes compared with no adhesive drapes for preventing surgical site infection

Patient or population: Patients undergoing surgery
Settings: Hospital
Intervention: Iodophore‐impregnated adhesive drapes
Comparison: No adhesive drapes

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

No adhesive drapes

Iodophore‐impregnated adhesive drapes

Surgical site infection
Inspection of the wound1
(follow‐up: 3 to 6 weeks)

Medium risk population

RR 1.03
(0.66 to 1.6)

1113
(2)

⊕⊕⊕⊝
Moderate2,3

45 per 1000

46 per 1000
(30 to 72)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 A number of definitions of wound infection were used across the trials. We accepted the authors definition in all cases.
2 Although information about allocation concealment was unclear in one trial (Dewan 1987) and outcome assessment was not blinded in the Segal 2002 trial, we have judged that this has not compromised the result.
3 There was imprecision on at least two counts; the total sample size was too small to meet optimal information size, and the total number of events was less than 300.

Figuras y tablas -
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Comparison 1. Adhesive drapes versus no adhesive drapes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Surgical site infection (all wound classifications) Show forest plot

5

3082

Risk Ratio (M‐H, Fixed, 95% CI)

1.23 [1.02, 1.48]

2 Surgical site infection (by wound classification) Show forest plot

1

921

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.86, 1.66]

2.1 Clean

1

363

Risk Ratio (M‐H, Fixed, 95% CI)

1.37 [0.53, 3.53]

2.2 Potentially infected

1

486

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.80, 1.92]

2.3 Infected

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.60, 1.75]

3 Length of hospital stay Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Infected wound

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 No infected wound

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 1. Adhesive drapes versus no adhesive drapes
Ir a la tabla de la revisión
Comparison 2. Iodine‐impregnated adhesive drapes versus no adhesive drapes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Surgical site infection Show forest plot

2

1113

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.66, 1.60]
Figuras y tablas -
Comparison 2. Iodine‐impregnated adhesive drapes versus no adhesive drapes
Ir a la tabla de la revisión