Isopropyl alcohol 70% / Hydrogen peroxide 0.125% spray

BackgroundReliable access to alcohol-based handrub (ABHR) is essential for hand hygiene and infection prevention, yet many low- and middle-income countries (LMICs) continue to face supply constraints. A 2011 WHO global assessment demonstrated that WHO-recommended ABHR formulations produced locally at low cost, were well accepted by healthcare workers, but also highlighted persistent barriers, including challenges in procuring ingredients and dispensers and in ensuring adequate quality control. This review aimed to provide an updated global synthesis of evidence on local ABHR production in healthcare settings.MethodsFollowing the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically searched Embase, Medline, and CINAHL from inception to 19 March 2025. Two reviewers independently conducted title-abstract screening, full-text screening and data extraction. Primary research articles reporting local ABHR production in healthcare settings in LMICs were eligible for data extraction and descriptive synthesis.ResultsOf 2343 articles screened, 31 studies from 19 countries were included (2006-2023). Over half (n = 18, 58%) were conducted during the COVID-19 pandemic; 22 described health-facility production and 9 described factory-level manufacturing. Of the 22 health-facility production studies, 12 (55%) used WHO Formulation 1 (ethanol-based) or modifications thereof. Pharmacists most commonly led production at the health-facility level. Only 6% (two articles) reported the source of alcohol, and less than half evaluated efficacy or organoleptic properties (13 and 12, respectively). Most funded studies relied on high-income-country (HIC) grants (17 of 24, 71%).ConclusionsLocal ABHR production remains infrequently reported in the literature, although publications increased during the COVID-19 pandemic. Heavy reliance on short-term, HIC-funded initiatives raises concerns about the long-term scalability and sustainability of local ABHR production in LMICs. Strengthening national regulatory capacity, quality-control laboratories, and sustainable financing is critical to maintain safe ABHR access beyond pandemic contexts, for resilient national supply chains and in-country quality control capacity.

Abstract licence: CC BY

Candidozyma auris is an emerging multidrug-resistant yeast that readily contaminates healthcare environments, persisting on dry surfaces and enabling transmission and difficult-to-control outbreaks. A systematic review of environmental hygiene interventions targeting C. auris was conducted, focusing on efficacy against planktonic cells and surface-associated biofilms (including dry-surface biofilms, DSB where available). PubMed and Scopus were searched for English-language records published from 1 January 2017 to 30 September 2025, and study selection followed PRISMA 2020. Thirty-six studies from nine countries met the inclusion criteria. These were predominantly laboratory efficacy evaluations using carrier/suspension or quantitative surface methods reporting log10 Colony Forming Unit (CFU) reductions; only seven studies assessed biofilm-associated C. auris. Across clades I-IV, chlorine-based disinfectants and oxidizing chemistries (hydrogen peroxide/peracetic acid formulations) most consistently achieved high-level reductions (often ≥ 5 log10 CFU) under label-relevant conditions. In contrast, products containing only quaternary ammonium compounds (QACs) frequently underperformed and demonstrated greater variability. No-touch methods, particularly 254 nm ultraviolet-C light (UV-C), provided meaningful adjunctive reductions, but were highly dependent on dose delivery and geometry, and evidence for ozone-based approaches was mixed. Limited data on C. auris DSBs suggest planktonic testing may overestimate real-world conditions and underscore the importance of endpoints, such as transfer prevention and regrowth suppression.

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BackgroundShoulder infections are an unfortunate and serious complication of surgery. The prevention strategy for infections is multimodal, with a strong reliance on surgical preparation solutions. There is great variability in the use of and effectiveness of surgical preparation solutions; this review aims to identify the most effective methods of shoulder surgical site preparation in the literature.MethodsA systematic review and meta-analysis was conducted by 2 independent reviewers in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) framework. Articles were screened by title, then abstract, and finally by full text by each clinician independently. A third orthopedic clinician adjudicated any disagreement on the application of the inclusion criteria. Studies included were human clinical studies utilizing skin preparation methods for the shoulder in a simulated or real primary surgery setting. English language databases from 1980 until the first of January 2025 were accessed. The terms searched included "shoulder," combined with each of the terms "skin," "wound," "antibiotic," "decolonization," "topical," "eradication," "preparation," and "sterilization." The results were pooled and then analyzed in subgroups according to the timing of skin preparation, the solution used, and the area of sampling.ResultsThe search found 13,154 articles, of which 31 studies were included in the final study and captured a total of 2,115 patients who were cultured for organisms. The lowest rates of culture positivity at the time of surgery were associated with the use of benzoyl peroxide (27.1% culture positive) and prior-to-day-of-surgery preparation solution administration (30.5% culture positive). Patients who received preparation solutions with alcohol numbered 1,551, of which 577 (37.2%) had positive cultures. Patients who received preparation solutions without alcohol numbered 564, with 140 (24.8%) culture positive, P P = .027, chi-square = 4.89.ConclusionThere is a wide range of available surgical preparation solutions to attempt to prevent day-of-surgery culture positivity. However, even the most robust regiments still have a substantially high culture positivity rate at the time of surgery. Further trials are warranted to unify protocols for the management of perioperative shoulder preparation.

Abstract licence: CC BY-NC-ND

BackgroundSurgical site infection (SSI) is a major concern in orthopaedic surgery procedures as they can have devastating consequences for patients and their outcomes. Many infection prevention measures are routinely taken in order to prevent infection during surgery, the main one being surgical skin preparation prior to any incision.AimTo investigate the efficacy of different perioperative surgical skin preparation products commonly used in orthopaedic surgery.MethodsSeven databases were searched from inception to January 25, 2025, using a combination of keywords and medical subject headings terms, specifically for studies comparing any two surgical skin preparation products used at any point prior to skin incision for orthopaedic procedures. Titles and abstracts were screened and full texts reviewed based on inclusion criteria. Data was extracted on study design, interventions, and outcomes from studies that met inclusion criteria. Meta-analysis was not completed due to heterogeneity.ResultsThirty-two studies met the inclusion criteria in this systematic review. In extremity fracture surgery, evidence was mixed on whether iodine or chlorhexidine-based solutions are more effective at preventing SSI. No significant difference was found between iodine and chlorhexidine-based solutions in total joint arthroplasty, spine surgery, foot and ankle surgery, or upper extremity surgery. No tested preparation method was superior in reducing positive Cutibacterium acnes culture rates in upper extremity (shoulder) surgery. Adding adjuncts to iodine and chlorhexidine methods, such as isopropyl alcohol, hydrogen peroxide, or benzoyl peroxide showed no significant changes to SSI or bacterial cultures.ConclusionCurrent literature shows no significant difference between chlorhexidine-based and iodine-based skin preparation solutions in orthopaedic extremity or spine surgery regarding SSI prevention or culture results. Likewise, adding other antiseptic agents provided no clear benefit. While skin antisepsis is important, many different factors contribute to SSI risk outside of the skin preparation solution.

Abstract licence: CC BY-NC

PurposeOur study aims to compare different perioperative treatments to reduce C. acnes, the most common causative agent of surgical site infections following shoulder surgery.MethodsA systematic search was performed in MEDLINE (PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and the Web of Science for studies published up to October 20, 2022. We included randomized-controlled trails investigating the efficacy of different dermal preparation in reducing the C. acnes colonising the skin surface. The studies examined positive bacterial cultures before and after skin treatment. The included trials were able to compare seven different skin treatment methods. We performed a frequentist network meta-analysis and calculated pooled risk ratios (RRs) with 95% confidence interval (CI).ResultsOur study could include comparisons of 946 different patients. The use of 5% benzoyl peroxide (BPO) and its combination with the antibiotic clindamycin was found to be the most effective in reducing C. acnes colonization on the skin (BPO 5% RR = 0.25, CI: 0.08-0.72, BPO with clindamycin RR = 0.25, CI: 0.04-1.50). Based on the rank plot, 5% BPO (P score: 0.808) was the most effective treatment, followed by BPO 5% with clindamycin (P score: 0.749). We could not perform a network meta-analysis regarding the efficacy of different dermal preparation in reducing C. acnes colonization on the dermis and in the joint.ConclusionCutibacterium colonization of the skin flora can be effectively reduced on the skin surface by the use of 5% BPO.

Abstract licence: CC BY