Ask an answerable question (PICO)：
Surgical Site Infection (SSI) is one of the common healthcare-associated infections (HAI), and Chlorhexidine gluconate (CHG) is a solution that has been widely used in skin disinfection in recent years. The effect of preoperative use of 2% CHG on SSI leads to a clinical question: "Whether preoperative skin preparation with 2% CHG in total knee arthroplasty can reduce the rate of surgical site infection?".
The Method and Analysis of Literature Review：
Creating keywords and synonyms through PICO, and searching in Cochrane library, PubMed, Embase and Airiti Library Huayi online library and other databases based on the principle of Boolean logic, a total of 20 documents were obtained. According to the inclusion and exclusion conditions, one systematic literature meta-analysis and one randomized controlled trial were selected. CASP was used to evaluate the effectiveness, importance, and applicability. Based on the 2011 Oxford Evidence Classification Criteria, the literatures were also graded.
Critical Appraisal：
CASP evaluates the validity, importance and applicability of the two literatures, and the level of evidence is between Level 1-2 in the light of the Oxford standard. Both literatures compare the use of 2% CHG and betadine before surgery on postoperative wound infection. The first conclusion indicated that preoperative use of 2% CHG skin preparation could reduce the risk of postoperative wound infection in moderate and high-risk patients, respectively (p=.007) and (p=.014), and the second was also agreed that 2% CHG could reduce the risk of postoperative wound infection (p=.049).
Clinical Application of Evidence：
Evidence-based on the empirical steps, use the 7 steps of empirical knowledge translation to improve the project. The orthopaedic ward of our hospital is selected as the implementation site, and the patients with total knee replacement are the subjects to receive the case. On March 31st, 2% CHG skin preparation was used as the intervention measure during the intervention period.
Evaluation of Effectiveness：
The overall infection rate of 302 patients treated with betadine skin preparation was 1.7% and the mean hospital stay was 8.2 days (SD = 4.74). The overall infection rate of 411 patients treated with 2% CHG skin preparation was 0.2% and the mean hospital stay was 7.65 days( SD=2.53). The total postoperative infection rate and the length of hospital stay were significantly different (p < .05).
Conclusions and Recommendations：
Pre-surgical skin preparation with 2% CHG can effectively reduce surgical site infection rates, healthcare costs, and working hours of nursing staff. This result could be possibly provided to other medical units as reference. It is suggested that a more rigorously designed randomization model can be used to conduct experimental studies in the future to confirm the effectiveness of the 2% CHG skin preparation regimen before knee arthroplasty.
