Effect of Surgical Skin Antisepsis on Surgical Site Infections in Patients Undergoing Gynecological Laparoscopic Surgery

Abstract

IMPORTANCE Gynecological laparoscopies are one of the most common surgical procedures worldwide. Limited evidence exists on rates of surgical site infections in patients undergoing gynecological laparoscopies and strategies to prevent these infections. OBJECTIVE To compare rates of port-site infections, organ or space infections, and any type of surgical site infections among patients who underwent gynecological laparoscopies and received 1 of 3 types of skin preparation solutions. DESIGN, SETTING, AND PARTICIPANTSA double-blind randomized clinical trial was conducted between February 28, 2017, and November 26, 2018, at a tertiary university-affiliated referral center. A total of 661 patients 18 years or older who underwent an elective operative laparoscopy for treatment of nonmalignant gynecological disorders were randomly assigned in a 1:1:1 ratio to have their skin cleaned before surgery with alcohol-based chlorhexidine, alcohol-based povidone-iodine, or water-based povidone-iodine. Statistical analysis was performed from February 28, 2017, to November 26, 2018. Analyses were performed on a modified intention-to-treat basis.INTERVENTIONS A total of 221 patients were randomized to have their skin prepared preoperatively with water-based povidone-iodine, 220 were randomized to alcohol-based povidone-iodine, and 220 were randomized to alcohol-based chlorhexidine. The patients were blinded to the solution used to clean their skin. Patients were followed up 1 and 4 weeks after surgery by a physician who was blinded to the skin preparation solution used at surgery. Evidence of infection according to Centers for Disease Control and Prevention criteria were documented. MAIN OUTCOMES AND MEASURESThe primary outcome of this study was port-site infection 30 days after surgery. Secondary outcomes were organ or space infections and any type of surgical site infections; the study also aimed to prospectively describe rates of surgical site infections in gynecological laparoscopies. RESULTSOf the 661 patients, 640 (96.8%; mean [SD] age, 36.2 [10.6] years) were examined after surgery by a physician at the study site and were included in the modified intention-to-treat analysis. The overall rate of port-site infection was 10.2% (65 of 640), rate of organ or space infection was 6.6% (42 of 640), and rate of any surgical site infection was 16.3% (104 of 640). The odds ratio for port-site infection for alcohol-based chlorhexidine vs water-based povidone-iodine was 1.13 (95% CI, 0.61-2.08), for alcohol-based chlorhexidine vs alcohol-based povidone-iodine was 1.34 (95% CI, 0.71-2.52), and for water-based povidone-iodine vs alcohol-based povidone-iodine was 1.19 (95% 0.62-2.27).CONCLUSIONS AND RELEVANCE Surgical site infections were more common than expected among patients who underwent gynecological laparoscopies. No skin preparation solution provided an advantage compared with the other solutions in reducing infection rates.

Sepsis Due to Port-Site Abscess in Laparoscopic Pelvic Lymphadenectomy: A Case Report

“…Among patients undergoing gynaecological laparoscopy surgical site infections are more common than might be expected; indeed, one recent study recorded a rate of 16.3% [1]. The port-site is one of the most frequent locations of infection (10.2% in the study just referenced) [1].…”

“…Gynaecological laparoscopy is a frequent surgical procedure worldwide [1]. The advantages of minimal access surgery are well known: fewer postoperative complications, early postoperative recovery, less pain, and early return to work [2].…”

Appropriateness and adherence to guidelines in perioperative antimicrobial prophylaxis in patients undergoing clean surgery: results from a Quality Control Circle intervention

“…Microorganisms resistance is the main causative elements of hospital acquired infections (HAIs) , of which surgical site infections (SSIs) are the most reported and surveyed type of HAI, and accounting for up to 20% of all HAI [3]. SSI is one of the most common and severe clinical complications after surgeries, often causes prolonged hospitalization and delayed postoperative therapy, and substantially increase the health-care costs [4,5]. Clean surgery is de ned as uninfected operative wound without in ammation, respiratory, alimentary, or genital of uninfected urinary track not entered according to the modi ed National Research Council wound classi cation criteria [6,7]{!!!…”

Pattern and aetiological factors of surgical site infection among patients undergone surgery in a tertiary care hospital

“…In other categories of surgical procedure including clean contaminated and dirty, the polymicrobial aerobic and anaerobic flora closely resembling the normal endogenous microflora of surgically resected organs are the most frequently isolated pathogens. 12 The single most disadvantage of those microbes is their multi-drug resistance property. Respiratory tract infections, Chronic renal failure etc.…”