Comparison of two different skin preparation strategies for open cardiac surgery

Abstract

Introduction: Surgical site infection (SSI) is a serious complication after cardiac surgery; skin preparation is an important step in the prevention of wound contamination with skin flora. In this study, two different skin preparation strategies (standard povidine iodine cleaning plus plain adhesive drape and microbial sealant (InteguSeal, Kimberly-Clark Health Care, Roswell, GA, USA) were compared in cardiac surgery patients. Methodology: This prospective study included 96 cardiac surgery patients randomized to either a standard plain adhesive drape (28 patients, control group) or a microbial sealant (68 patients, study group). Bacterial isolates were obtained from the wounds in the operating room before the skin incision and after the surgical procedure had ended. Results: Microorganisms were isolated from 38 patients (39.6%) in the study population. Twenty-seven of these patients were from the microbial sealant group and 11 were from the plain adhesive drape group. No postoperative wound infection was encountered in either group. No statistically significant differences between the two groups regarding the number of patients with microorganism isolation (p = 0.974) or postoperative leukocyte counts and neutrophil granulocyte percentages were observed. Conclusions: Regarding SSI after cardiac surgery, microbial sealant is equivalent to the standard skin preparation strategy applied with povidine iodine cleaning and a plain adhesive drape.

Rehospitalization with surgical site infections after cardiac surgery

“…Investigating skin preparation modalities, such as hair removal and preoperative antiseptic showering, would build further evidence for best nursing practice and help nurse managers to develop and implement a protocol for appropriate preoperative skin preparation. [2,3] Although postoperative wound care and dressing is well-investigated in the literature, there is a limited number of data regarding the timing for the first dressing as the predictor for SSIs. Timing of the first postoperative dressing affects the inflammatory phase of wound healing.…”

“…Surgical site infections (SSIs) are serious perioperative complications which accounts for about 2% of surgical procedures and they may have a devastating impact on the course of treatment. [1][2][3] These infections are also associated with increased treatment intensity and prolonged length of hospital stay, and higher cumulative healthcare costs and substantial morbidity and mortality rates. [3] Infectious complications after cardiac surgery, which occur in 5 to 21% of cases, are well-known and difficult-to-treat problems which increase patients' suffer, healthcare cost, and postoperative mortality rates by more than five times with prolonged recovery.…”

“…Risk factors related to hospitalization and hospital setting are duration of preoperative stay and patient preparation. [2,5,7] These predictors may result in development of SSIs after cardiac surgery through three common physiological pathways: decreased collagen synthesis, vasoconstriction, and increased immunosuppression. [3] In the literature, several studies have been undertaken to identify high-risk patients for infectious complications in an attempt to modify risk factors.…”