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

Joan Webster; Abdullah Alghamdi

doi:10.1002/14651858.CD006353.pub4

Uso de paños adhesivos plásticos durante la cirugía para la prevención de la infección del sitio quirúrgico

Contraer todo Desplegar todo

Referencias

References to studies included in this review

Ir a:

estudios excluidos
otras referencias

Chiu KY, Lau SK, Fung B, Ng KH, Chow SP. Plastic adhesive drapes and wound infection after hip fracture surgery. Australian and New Zealand Journal of Surgery 1993;63:798‐801.

Cordtz T, Schouenborg L, Laursen K, Daugaard HO, Buur K, Munk Christensen B, et al. The effect of incisional plastic drapes and redisinfection of operation site on wound infection following caesarean section. Journal of Hospital infection 1989;13(3):267‐72.

Dewan PA, Van Rij AM, Robinson RG, Skeggs GB, Fergus M. The use of an iodophor‐impregnated plastic incise drape in abdominal surgery ‐ a controlled clinical trial. Australian and New Zealand Journal of Surgery 1987;57(11):859‐63.

Jackson DW, Pollock AV, Tindal DS. The value of a plastic adhesive drape in the prevention of wound infection. A controlled trial. British Journal of Surgery 1971;58(5):340‐2.

Psaila JV, Wheeler MH, Crosby DL. The role of plastic wound drapes in the prevention of wound infection following abdominal surgery. British Journal of Surgery 1977;64(10):729‐32.

Segal CG, Anderson JJ. Preoperative skin preparation of cardiac patients. AORN Journal 2002;76(5):821‐8.

Ward HR, Jennings OG, Potgieter P, Lombard CJ, Ward HR, Jennings OG, et al. Do plastic adhesive drapes prevent post caesarean wound infection?. Journal of Hospital Infection 2001;47(3):230‐4.

References to studies excluded from this review

Ir a:

estudios incluidos
otras referencias

Breitner S, Ruckdeschel G. Bacteriologic studies of the use of incision drapes in orthopedic operations. Unfallchirurgie 1986;12(6):301‐4.

Duvvi SK, Lo S, Spraggs PD. A plastic drape in nasal surgery. Plastic and Reconstive Surgery 2005;116(7):2041‐2.

Fairclough JA, Johnson D, Mackie I. The prevention of wound contamination by skin organisms by the pre‐operative application of an iodophor impregnated plastic adhesive drape. Journal of International Medical Research 1986;14(2):105‐9.

Falk‐Brynhildsen K, Friberg O, Söderquist B, Nilsson UG. Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drapes compared with bare skin. Journal of Hospital Infection 2013;84:151‐158.

French ML, Eitzen HE, Ritter MA. The plastic surgical adhesive drape: an evaluation of its efficacy as a microbial barrier. Annals of Surgery 1976;184(1):46‐50.

Ha'eri GB. The efficacy of adhesive plastic incise drapes in preventing wound contamination. International Surgery 1983;68(1):31‐2.

Lewis DA, Leaper DJ, Speller DC. Prevention of bacterial colonization of wounds at operation: comparison of iodine‐impregnated ('Ioban') drapes with conventional methods. Journal of Hospital Infection 1984;5(4):431‐7.

Manncke M, Heeg P. Experimental and clinical studies of the efficacy of an antimicrobial incision drape. Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen 1984;55(8):515‐8.

Maxwell JG, Ford CR, Peterson DE, Richards RC. Abdominal wound infections and plastic drape protectors. American Journal of Surgery 1969;116(6):844‐8.

Nystrom PO, Brote L. Effects of a plastic wound drape on contamination with enterobacteria and on infection after appendicectomy. Acta Chirurgica Scandinavica 1980;146(1):67‐70.

Google Scholar

Nystrom PO, Broome A, Hojer H, Ling L. A controlled trial of a plastic wound ring drape to prevent contamination and infection in colorectal surgery. Diseases of the Colon and Rectum 1984;27:451‐3.

Swenson BR, Camp TR, Mulloy DP, Sawyer RG. Antimicrobial‐impregnated surgical incise drapes in the prevention of mesh infection after ventral hernia repair. Surgical infections 2008;9(1):23‐32.

Williams JA, Oates GD, Brown PP, Burden DW, McCall J, Hutchison AG, et al. Abdominal wound infections and plastic wound guards. British Journal of Surgery 1972;59(2):142‐6.

Yoshimura Y, Kubo S, Hirohashi K, Ogawa M, Morimoto K, Shirata K, et al. Plastic iodophor drape during liver surgery operative use of the iodophor‐impregnated adhesive drape to prevent wound infection during high risk surgery. World Journal of Surgery 2003;27(6):685‐8.

Additional references

Ir a:

estudios incluidos
estudios excluidos

Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Annals of Surgery 2011;253:1083‐93.

Bruce J, Russell EM, Mollinson J, Krukowski ZH. The measurement and monitoring of surgical adverse events. Health Technology Assessment 2001;5:1‐194.

Coello R, Charlett A, Wilson J, Ward V, Pearson A, Borriello P. Adverse impact of surgical site infections in English hospitals. Journal of Hospital Infection 2005;60:93‐103.

Edwards PS, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD003949.pub2]

Google Scholar

Falk‐Brynhildsen K, Friberg O, Söderquist B, Nilsson UG. Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes. Biological Research for Nursing2013; Vol. 15:242‐248. [DOI: 10.1177/1099800411430381]

Google Scholar

Fleischmann W, Meyer H, von Baer A. Bacterial recolonization of the skin under a polyurethane drape in hip surgery. Journal of Hospital Infection 1996;34(2):107‐16.

Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS. Surgical site infection (SSI) rates in the United States, 1992‐1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clinical Infectious Diseases 2001;33(Suppl 2):S69‐77.

Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21:539‐58.

Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8. Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Kashimura N, Kusachi S, Konishi T, Shimizu J, Kusunoki M, Oka M, et al. Impact of surgical site infection after colorectal surgery on hospital stay and medical expenditure in Japan. Surgery Today 2012 Jan 31 [Epub ahead of print].

Katthagen BD, Zamani P, Jung W. Effect of surgical draping on bacterial contamination in the surgical field. Zeitschrift für Orthopädie und ihre Grenzgebiete 1992;130:230‐5.

Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean‐contaminated cases. Indian Journal of Medical Microbiology 2005;23:249‐52.

Lilly HA, Lowbury EJ, London PS, Porter MF. Effects of adhesive drapes on contamination of operation wounds. Lancet 1970;7670:431‐2.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guidelines for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infection Control and Hospital Epidemiology 1999;20:250‐78.

Nichols RN. Surgical infections: prevention and treatment ‐1965 to 1995. American Journal of Surgery 1996;172(1):68‐74.

Payne JT. An adhesive surgical drape. American Journal of Surgery 1956;91:110‐12.

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.

Ritter MA, Campbell ED. Retrospective evaluation of an iodophor‐incorporated antimicrobial plastic adhesive wound drape. Clinical Orthopaedics and Related Research 1988;228:307‐8.

Scottish Intercollegiate Guidelines Network (SIGN). Search filters. www.sign.ac.uk/methodology/filters.html#random (Accessed 10 August 2012).

Smyth ET, Emmerson AM. Surgical site infection surveillance. Journal of Hospital Infection 2000;45:173‐84.

Thompson KM, Oldenburg WA, Deschamps C, Rupp WC, Smith CD. Chasing zero: the drive to eliminate surgical site infections. Annals of Surgery 2011;254(3):430‐6.

Zokaie S, White IR, McFadden JD. Allergic contact dermatitis caused by iodophor‐impregnated surgical incise drape. Contact Dermatitis 2011;65(5):309.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos

Chiu 1993

Methods	Study type: single‐centre RCT Follow‐up period: 6 months
Participants	People undergoing acute hip fracture surgery
Interventions	Opsite (Smith & Nephew) adhesive plastic incisional drapes compared with no incisional drapes
Outcomes	Surgical wound infection (reported as deep and superficial infection). No definition of infection provided Bacterial colonisation
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Method not described
Allocation concealment (selection bias)	Unclear risk	Method not described
Blinding (performance bias and detection bias) All outcomes	High risk	Masking was impossible for surgeons It is unclear if patients were aware of their group allocation Whether outcome assessors were masked is unclear. The author states "After the operation, the wound was observed for clinical infection" but there was no indication of who undertook this assessment nor if those assessing the outcome were aware of the group allocation
Incomplete outcome data (attrition bias) All outcomes	Low risk	The authors state that 120 patients were enrolled and results were available for all of these patients. No mention of intention‐to‐treat analysis was made
Selective reporting (reporting bias)	Low risk	Results for all expected outcomes were reported
Other bias	Low risk	No competing interests were declared. Although no data were shown, the authors stated that patients were matched for relevant risk factors at baseline

Cordtz 1989

Methods	Study type: multi‐centre RCT Follow‐up period: 14 days
Participants	Women undergoing caesarean section. Includes infected and possibly infected cases
Interventions	Adhesive plastic incisional drapes compared with no adhesive plastic incisional drapes
Outcomes	Surgical wound infection (defined as possibly infected if there was localised erythema and/or serous secretion without the presence of pus)
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random allocation, using block design, in blocks of eight
Allocation concealment (selection bias)	Unclear risk	Not described. However, the study, which included eight hospitals, was carried out under the supervision of the Danish National Centre for Hospital Hygiene, so it is likely that an appropriate method of allocation concealment was used
Blinding (performance bias and detection bias) All outcomes	High risk	Masking was impossible for surgeons It is unclear if patients were aware of their group allocation Whether outcome assessors were masked is unclear. The author states "Post‐operative observations of the wounds were continued in hospital until the fourteenth post‐operative day" but there was no indication of who undertook this assessment nor if the assessors were aware of the group allocation
Incomplete outcome data (attrition bias) All outcomes	Low risk	64 patients were excluded before randomisation but details by group were not provided. No mention of intention‐to‐treat analysis was made
Selective reporting (reporting bias)	Low risk	Results for all expected outcomes were reported
Other bias	Low risk	No competing interests declared. No baseline data reported

Dewan 1987

Methods	Study type: single‐centre RCT Follow‐up period: 3 weeks
Participants	People undergoing general surgery
Interventions	Ioban (3M Company) iodine‐impregnated adhesive plastic incisional drapes compared with no incisional drapes
Outcomes	Surgical wound infection (defined as a wound that discharged pus or if the fluid discharging from the wound was associated with a positive bacterial culture or if erythema was present more than 1cm lateral to the wound) Death Bacterial colonisation
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random number table
Allocation concealment (selection bias)	Low risk	Surgeons sequentially selected the allocation from the random numbers table located in the operating room Consequently, surgeons would have been aware of the next allocation
Blinding (performance bias and detection bias) All outcomes	High risk	Masking was impossible for surgeons It is unclear if patients were aware of their group allocation Outcome assessment was masked "Postoperatively, wound follow‐up was carried out by the infection control nurse who was unaware whether the drape had been used or not"
Incomplete outcome data (attrition bias) All outcomes	Low risk	86 (7.8%) patients were excluded after randomisation (40 for incomplete records and 46 because they were unable to be followed up for the three‐week period considered necessary). These were not displayed by group
Selective reporting (reporting bias)	Low risk	Results for all expected outcomes were reported
Other bias	Low risk	No competing interests declared. Patients equally distributed for all major risk factors for surgical site infection

Jackson 1971

Methods	Study type: single‐centre RCT Follow‐up period: 1 month
Participants	People undergoing general surgery
Interventions	Adhesive plastic incisional drapes (Band‐aid) compared with no adhesive plastic incisional drapes
Outcomes	Surgical wound infection (defined as a wound discharging pus and included stitch abscess)
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Spin of a coin
Allocation concealment (selection bias)	Low risk	The coin was 'spun' at the beginning of the operation. Allocation would have been concealed until then and the next allocation would be unpredictable
Blinding (performance bias and detection bias) All outcomes	High risk	Masking was impossible for surgeons It is unclear if patients were aware of their group allocation Two of the authors, who were also surgeons involved in the trial, followed up all patients until one month after the surgery to record any wound infection
Incomplete outcome data (attrition bias) All outcomes	Low risk	Follow‐up data was reported on all enrolled participants
Selective reporting (reporting bias)	Low risk	Results for all expected outcomes were reported
Other bias	Unclear risk	The investigators "concurrently ran a test of an antibiotic spray in random cases." Results were to be reported separately. It is unclear if the spray was used equally between groups No baseline data were reported. No competing interests reported

Psaila 1977

Methods	Study type: Single‐centre RCT Follow‐up period: Not defined
Participants	People undergoing abdominal surgery
Interventions	Adhesive plastic incisional drapes compared with no adhesive plastic incisional drapes and a ring drape
Outcomes	Surgical wound infection (defined as erythema around sutures or wound edge with an accompanying pyrexia; discharge or exudate from the wound; wound breakdown) Bacterial colonisation
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Method not described
Allocation concealment (selection bias)	Unclear risk	Method not described
Blinding (performance bias and detection bias) All outcomes	High risk	Masking was impossible for surgeons It is unclear if patients were aware of their group allocation Wounds were inspected daily after the third day to identify evidence of infection but it is not clear who did this; nor if the assessors were aware of the patients allocation status
Incomplete outcome data (attrition bias) All outcomes	Low risk	All enrolled patients were accounted for in the results
Selective reporting (reporting bias)	Low risk	Results for all expected outcomes were reported
Other bias	Unclear risk	No baseline data were reported. No competing interests reported

Segal 2002

Methods	Study type: single‐centre RCT Follow‐up period: 6 weeks
Participants	People at high risk undergoing cardiac surgery
Interventions	Iodine‐impregnated adhesive plastic incisional drapes compared with no incisional drapes
Outcomes	Surgical wound infection. No clear definition of infection but included drainage, redness, tenderness or instability
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Pieces of paper marked with equal numbers of the different allocations were placed in a sack
Allocation concealment (selection bias)	Low risk	When an eligible patient was identified, a piece of paper containing the allocation was drawn out of the sack by the operating room Charge Nurse
Blinding (performance bias and detection bias) All outcomes	High risk	Masking was impossible for surgeons It is unclear if patients were aware of their group allocation The person assessing the outcome was aware of the patient's allocation group
Incomplete outcome data (attrition bias) All outcomes	Low risk	All enrolled patients were followed up
Selective reporting (reporting bias)	Low risk	Results for all expected outcomes were reported
Other bias	Low risk	Patients equal at baseline for risk factors (communication with authors). No competing interests

Ward 2001

Methods	Study type: single‐centre RCT Follow‐up period: 5 days
Participants	Women undergoing caesarean section
Interventions	Incise (Smith & Nephew) adhesive plastic incisional drapes compared with no adhesive plastic incisional drapes
Outcomes	Surgical wound infection (defined as having to include 2 of the following: erythema around sutures or wound edge; seropurulent discharge from the wound; positive swab culture) Number of days in hospital
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random number table
Allocation concealment (selection bias)	Low risk	Allocation contained in opaque unmarked envelope
Blinding (performance bias and detection bias) All outcomes	Low risk	Masking was impossible for surgeons Patients were blind to their allocation as the drape was placed after anaesthetic induction Outcome assessment was blinded, postoperative care was provided by staff unrelated to surgery
Incomplete outcome data (attrition bias) All outcomes	Low risk	Of the 620 patients randomised, 15 (2.4%) had critical data missing from their records and a further two patients were excluded, one for an existing infection and one for early discharge
Selective reporting (reporting bias)	Low risk	Results for all expected outcomes were reported
Other bias	Unclear risk	Patients were only followed up for 5 days; some infections would have occurred after this time. Baseline risk factors were equally distributed between groups

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Breitner 1986	Not a RCT
Duvvi 2005	Not a RCT
Fairclough 1986	Not a RCT
Falk‐Brynhildsen 2013a	Did not report wound infection rate
French 1976	Did not report wound infection rate
Ha'eri 1983	Did not report wound infection rate
Lewis 1984	Number of participants in each treatment arm not reported
Manncke 1984	Did not report wound infection rate
Maxwell 1969	Not a RCT
Nystrom 1980	Plastic incisional drape not used
Nystrom 1984	Plastic incisional drape not used
Swenson 2008	Not a RCT
Williams 1972	Plastic incisional drape not used
Yoshimura 2003	Not a RCT

RCT: randomised controlled trial

Data and analyses

Open in table viewer

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]
Open in figure viewer Analysis 1.1 Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 1 Surgical site infection (all wound classifications).
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]
Open in figure viewer Analysis 1.2 Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 2 Surgical site infection (by wound classification).
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
Open in figure viewer Analysis 1.3 Comparison 1 Adhesive drapes versus no adhesive drapes, Outcome 3 Length of hospital stay.
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]

Open in table viewer

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]
Open in figure viewer Analysis 2.1 Comparison 2 Iodine‐impregnated adhesive drapes versus no adhesive drapes, Outcome 1 Surgical site infection.

Figure 1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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)	⊕⊕⊕⊕ High^3,4
	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.

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)	⊕⊕⊕⊝ Moderate^2,3
	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.

Ir a la tabla de la revisión

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]

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]

Comparison 2. Iodine‐impregnated adhesive drapes versus no adhesive drapes

Ir a la tabla de la revisión

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Referencias

References to studies included in this review

Chiu 1993 {published data only}

Cordtz 1989 {published data only}

Dewan 1987 {published data only}

Jackson 1971 {published data only}

Psaila 1977 {published data only}

Segal 2002 {published data only}

Ward 2001 {published data only}

References to studies excluded from this review

Breitner 1986 {published data only}

Duvvi 2005 {published data only}

Fairclough 1986 {published data only}

Falk‐Brynhildsen 2013a {published data only}

French 1976 {published data only}

Ha'eri 1983 {published data only}

Lewis 1984 {published data only}

Manncke 1984 {published data only}

Maxwell 1969 {published data only}

Nystrom 1980 {published data only}

Nystrom 1984 {published data only}

Swenson 2008 {published data only}

Williams 1972 {published data only}

Yoshimura 2003 {published data only}

Additional references

Alexander 2011

Bruce 2001

Coello 2005

Edwards 2009

Falk‐Brynhildsen 2013

Fleischmann 1996

Gaynes 2001

Higgins 2002

Higgins 2011

Kashimura 2012

Katthagen 1992

Lefebvre 2011

Lilani 2005

Lilly 1970

Mangram 1999

Nichols 1996

Payne 1956

RevMan 2011 [Computer program]

Ritter 1988

SIGN 2012

Smyth 2000

Thompson 2011

Zokaie 2011

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

Copiar o descargar referencia

Idioma de la Revisión Cochrane

Idioma de la web

Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso