Bacterial Recolonization During Foot Surgery: A Prospective Randomized Study of Toe Preparation Techniques

Abstract

Fifty patients undergoing foot or ankle surgery were randomized into two groups for the purposes of toe preparation. Twenty-four patients underwent a standard preparation which included placing antiseptic between the toes while 26 were additionally cleaned by sliding a gauze swab soaked in topical antiseptic back and forth several times. Povidone iodine followed by chlorhexidine in alcohol was used in both groups. All toes were covered by a sterile glove during surgery unless the toes themselves were to be operated upon. Bacteria were cultured from the toe clefts in 4% of all patients immediately following preoperative disinfection. Significantly fewer patients whose toes had been additionally scrubbed (group 1) showed bacterial recolonization at the end of surgery compared with those undergoing a standard prep (group 2) (7.7% vs 20.8%). We conclude that additional scrubbing of toe clefts prior to surgery reduces the incidence of recolonization of bacteria during the surgical procedure.

What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

“…Other comorbidities associated with increased risk of postoperative infection include obesity, malnutrition, tobacco use, and immunosuppressive medication [11,21,43,45]. Another potential cause for greater concern for surgical site infections after foot and ankle surgery is the persistent colonization of the forefoot despite preoperative preparation [7,12,30,47,48,63,65]. Ostrander et al [47] reported positive cultures after application of surgical preparation solution in 125 patients, ranging from 23% to 98% from the hallux nailfold and second and third web spaces, compared with 10% to 35% from the anterior tibia control.…”

“…Investigation to decrease infectious risk in foot and ankle surgery has been largely preoperative, including preoperative risk stratification [17,21,59,64] and evaluation of antiseptic skin preparations [7,12,30,47,48]. An additional measure taken by some foot and ankle surgeons is planned use of a brief course of prophylactic postoperative oral antibiotics after elective outpatient procedures.…”

Recomendaciones prácticas para la antisepsia de la piel del paciente antes de cirugía

“…Los productos basados en yodo povidona se inactivan con la presencia de material orgánico. -La limpieza de la piel antes de la preparación antisépti-ca para cirugía fue más efectiva en reducir la carga bacteriana que la aplicación de antiséptico únicamente (21,29) Sin embargo, Lefebvre et al, realizaron una revisión y meta análisis (7 estudios con 1650 pacientes) con el fin de evaluar la ventaja de aplicar un lavado exhaustivo previo a la aplicación de la solución antiséptica con respecto al riesgo de ISO y no encontraron diferencias (RR. 1.02 IC 95% 0.82, 1.26).…”

“…Finalmente, un metaanálisis que incluyó estudios con diferentes comparaciones para cirugía limpia identificó beneficio en el uso de solución alcohó-lica con clorhexidina al 0.5% comparado con una solución alcohólica de yodo povidona con un reducción del riesgo de infección del 53% (RR 0,47, IC95% 0,27-0,82 30 . Adicionalmente un estudio que comparó la diferencia entre clorhexidina+alcohol Vs yodo povidona+alcohol y el riesgo de infección del sitio quirúrgico en 1147 mujeres sometidas a cesárea, demostró una superioridad de la clorhexidina (riesgo relativo de 0,55; IC 95%, 0,34 to 0,90; P=0,02) 29 . -En general para la preparación antiséptica de la piel del sitio quirúrgico se recomienda el uso de una solución alcohólica (alcohol isopropílico al 70%) de GCH al 2%.…”

Practical Recommendations for Preoperative Skin Antisepsis

“…The products made of povidone iodine are inactivated with the presence of organic material. -Cleansing the skin prior to antiseptic preparation for surgery was more effective in reducing the bacterial load than using only the antiseptic application 21,29 ). However, Lefebvre et al Performed a review and metaanalysis ( 7 studies with 1650 patients) in order to evaluate the advantage of applying a thorough cleansing prior to the application of the antiseptic solution with respect to SSI risk and found no differences (RR 1.02, 95% CI 0.82, 1.26).…”