Can sterility of stripped iodophor-impregnated plastic adhesive drape be maintained at the time of incision closure in total hip arthroplasty?

Tonotsuka, Hisahiro; Sugiyama, Hajime; Tanaka, Daisuke; Ito, Tatsuto; Amagami, Ayano; Yonemoto, Keigo; Sato, Ryuichi; Saito, Mitsuru; Marumo, Keishi

doi:10.5152/j.aott.2020.19084

Cited by 1 publication

(1 citation statement)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further evidence suggests that any benefit of adhesive drapes can be negated, or potentially reversed, with peel back from the surgical wound during the procedure. Tonotsuka et al [16] conducted a recent nonrandomized study of 225 patients undergoing THA with the use of an iodophor-impregnated adhesive drape. The authors found more than a twofold increase in skin contamination beneath the peeled-off drape before wound closure compared with before the application of an adhesive drape (10% versus 4%; p < 0.01).…”

Section: Discussionmentioning

confidence: 99%

Do Adhesive Drapes Have an Effect on Infection Rates in Orthopaedic Surgery? A Systematic Review and Meta-Analysis

Mundi

Nucci

Ekhtiari

et al. 2021

Clin Orthop Relat Res

View full text Add to dashboard Cite

BackgroundAdhesive surgical drapes are purported to reduce the rates of surgical site infection. Despite that, international surgical guidelines generally recommend against the use of such drapes; however, this is primarily based on nonorthopaedic evidence.Questions/purposes(1) Does the use of adhesive drapes decrease the risk of wound contamination? (2) Does intraoperative drape peeling (intentional or inadvertent) increase the risk of wound contamination? (3) Does the use of adhesive drapes decrease the risk of surgical site infection?MethodsA systematic review of the MEDLINE and Embase databases was performed according to the Cochrane Handbook methods for randomized controlled trials (RCTs) published since 2000 and comparing adhesive drapes with controls. All databases were searched from inception to March 1, 2021. A pooled meta-analysis was performed, where possible. The Cochrane Risk of Bias Assessment Tool was used to assess risk of bias among the included studies. From among 417 search results, five eligible RCTs were identified and included, all of which were published between 2018 and 2020. There were a total of 2266 patients, with 1129 (49.8%) in the adhesive drape groups, and 1137 (50.2%) in the control groups. The studies included hip and knee surgery trials (n = 3 trials; 1020 patients in intervention groups and 1032 patients in control groups) as well as trials on shoulder arthroscopy (n = 1 trial; 65 patients in the intervention group and 61 patients in the control group) and lumbar spine surgery (n = 1 trial; 44 patients in each group). The data for all three outcomes (wound contamination, impact of intraoperative peeling, and surgical site infection) revealed low heterogeneity based on random-effects models (I2 = 14%, 0%, and 0%, respectively).ResultsBased on data from pooled wound swab culture results from four studies, a reduction in wound contamination was associated with the use of adhesive drapes (odds ratio 0.49 [95% CI 0.34 to 0.72]; p < 0.001). The available evidence was inconclusive to determine whether intraoperative drape peeling (intentional or inadvertent) influenced the risk of wound contamination. Three studies did not report on this outcome, one study found an increased infection rate with drape peel back, and another study found a reduced treatment effect of adhesive drapes when peel back occurred in a subgroup analysis. The two studies that analyzed surgical site infections reported no infections in either arm; therefore, we could not answer the question of whether adhesive drapes affect risk of surgical site infection.ConclusionThe findings of this review suggest that adhesive drapes, including those with antimicrobial properties, decrease the risk of wound contamination during orthopaedic procedures. In circumstances where drape adhesion is compromised and peel back occurs at the wound edge, there is an increased risk of wound contamination with the use of adhesive drapes. The best currently available evidence is indeterminate as to the effect of adhesive drapes on the ...

show abstract

Section: Discussionmentioning

confidence: 99%