Purpose:
After clean surgery, patient education for surgical wound care was based on surgeon’s preference. Some surgeons suggested use topical antimicrobial agents for wound dressing, some may suggested use topical antiseptic agents for wound dressing, while others may suggested use neither of them. Whether to give patients topical antimicrobial agents or topical antiseptic agents was an issue we should discuss.
Surgical-site infections (SSIs) increase patient morbidity and costs, and may annoy both surgeons and patients. In this article, from the point of view of preventing surgical site infections, we are going to discuss the necessity to give topical antimicrobial agents or antiseptic agents in wounds healing by primary intention.

Materials and Methods:
We used the principle of evidence-based medicine to search systemic review article or randomized control studies within recent 5 years from Cochrane Library, Embase, PubMed and Ariti Library. C. F. Heal et al. from British Journal of Surgery in 2017 was chosed. The conclusion from this meta-analysis (14 studies) was topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. However, due to high risk of bias because of different inclusion criteria from studies, we excluded the studies that included operations at emergency department and / or cesarean section. Therefore, we re-analyzed the result of 3 studies in “new meta-analysis”, we found that there was no clear difference between antibiotics group and no antibiotic group in SSIs.
From the perspective of Taiwan’s medical environment, we did a questionnaire survey to analyze the preference in wound dressing in Shin Kong Wu Ho-Su Memorial Hospital, and 40% of surgeons preferred topical antibiotics usage for wound dressing, while 60% of surgeons preferred not using topical antibiotics. We then started a retrospective analysis for SSIs after clean surgery.

Results:
In our retrospective analysis, there was 247 patients received clean surgery from 20th October 2020 to 22nd November 2020. 182 patients used topical antibiotics for wound dressing after operation, while another 65 patients were not given topical antibiotics for wound dressing after operation. Only 3 SSIs in topical antibiotics group (1.65%), and only 1 SSI in control group (1.54%). There was no clear difference between using topical antibiotics and control group.

Conclusion:
There was no clear difference between using topical antibiotics and not using it in preventing SSIs in clean surgery. This study may be helpful for the cost effectiveness in saving Taiwan’s medical resources. Our study has contributed additional evidence, although practice must be guided by clinical judgement of risks and benefits. However, patient’s requirement might still be the obstacle for not using topical antibiotics in clean surgery. Additionally, larger sample size and multi-center study may be needed in the future.