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World J Methodol. Jul 20, 2021; 11(4): 222-227
Published online Jul 20, 2021. doi: 10.5662/wjm.v11.i4.222
Wound irrigation for preventing surgical site infections
Marios Papadakis
Marios Papadakis, Department of Surgery II, University of Witten-Herdecke, Wuppertal 42283, Germany
Author contributions: Marios Papadakis was involved in the study conceptualization, literature research, project administration, and writing of the original draft.
Conflict-of-interest statement: Author has nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marios Papadakis, MD, MSc, Research Scientist, Surgeon, Department of Surgery II, University of Witten-Herdecke, Heusnerstrasse 40, Wuppertal 42283, Germany. marios_papadakis@yahoo.gr
Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: May 6, 2021
Revised: May 6, 2021
Accepted: June 25, 2021
Article in press: June 25, 2021
Published online: July 20, 2021
Processing time: 147 Days and 7.4 Hours
Abstract

Wound irrigation (i.e. washing out a wound before wound closure) aims to reduce the microbial burden by removing tissue debris, metabolic waste, and tissue exudate from the surgical field before site closure. Although it is a popular procedure in every day surgical practice, the lack of procedure standardization, leads to studies with high heterogeneity and often controversial results. Thus, there are studies that advocate its use, while others discourage its implementation in clinical practice to reduce the risk of surgical site infection. The present article reviews the current literature on wound irrigation for preventing surgical site infections. Several irrigants are presented. Chlorexidine is generally considered to be less effective than povidone-iodine, while antibiotics are not that common nowadays, as they require prolonged exposure with the target to act. Hydrogen peroxide has several potential complications, which eliminate its use. Any differences in the incidence of surgical site infections between different irrigants, especially between antibacterial and non-bacterial ones, should be viewed sceptically. More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants' effectiveness and safety.

Keywords: Wound irrigation; Surgical site infections; Antiseptics; Antibiotics; Patient Safety

Core Tip: Chlorexidine is generally considered to be less effective than povidone-iodine, while antibiotics are not that common nowadays, as they require prolonged exposure with the target to act. Hydrogen peroxide has several potential complications, which eliminate its use. Any differences in the incidence of surgical site infections between different irrigants, especially between antibacterial and non-bacterial ones, should be viewed sceptically.