Antibiotics and antiseptics in surgical wound washes. Are they useful?

Many surgical procedures are conducted every year. The majority of these procedures result in wounds that heal by primary intention, which means that the wound edges are approximated using sutures, staples, clips or glue.

Most wounds heal without complications but surgical site infections can occur after surgery in the site where the surgery took place. SSIs are infections of the incision, organ or space that occur after surgery. Most wound infections are caused by contamination with the patient’s own micro-organisms during surgery.

Surgical patients initially seen with more complex comorbidities and the emergence of antimicrobial resistant pathogens increase the cost and challenge of treating SSIs. The prevention of SSI is increasingly important as the number of surgical procedures performed in the world continues to rise. Public reporting of process, outcome, and other quality improvement measures is required, while reimbursements for treating SSIs are being reduced or denied. It has been estimated that approximately half of SSIs are preventable by applying evidence-based strategies.

Intraoperative surgical site irrigation is common practice in surgical procedures in general, with all disciplines advocating some form of irrigation before incision closure. This is intended to reduce SSI, using different types of agents such as antibiotics and antiseptics. This practice, however, has not been standardized, nor is there compelling evidence that it effectively reduces the risk of wound infections.