Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates A Prospective Study of 3 Skin Preparation Protocols

Abstract

OBJECTIVE To compare the effects of different skin preparation solutions on surgical-site infection rates. DESIGN Three skin preparations were compared by means of a sequential implementation design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner. SETTING Single large academic medical center. PATIENTS All adult general surgery patients. RESULTS The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001). CONCLUSIONS Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to chlorhexidine for this purpose in general surgery patients.

Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty

“…Climo et al compared the infection rates of intensive care unit patients following daily bathing with either soap and water (2,670 patients) or chlorhexidine solution (2,650 patients) over a one year period [5]. The authors reported a significantly lower incidence of acquisition of methicillin-resistant Staphylo- Swenson et al compared the surgical infection rates following operating room skin preparation with one of three solutions: (1) povidone-iodine scrub and paint, (2) 2% chlorhexidine/70% isopropyl paint and (3) iodine povacrylex paint [19]. The authors found a significantly higher post-operative infection rate with the use of the chlorhexidine preparation (8.2%) as compared to the other regimens (both 4.8%, p=0.001).…”

The Importance of Isopropyl Alcohol in Skin Preparation Solutions

“…2 We found that rates of SSIs were significantly decreased when iodophore-based skin preparation solutions containing IPA were used, compared with SSI rates when solutions of chlorhexidine plus IPA were used. Because all preparation protocols included IPA, we could isolate the nonalcohol component (chlorhexidine, iodine-providone, and iodine povacrylex were used in our study), and we concluded that iodine-based solutions were most likely superior to chlorhexidine-based solutions in both intention-to-treat and per-protocol models.…”

“…To the Editor-We thank Maiwald et al 1 and Riccio et al 2 for their interest in our meta-analysis, which reported a decreased number of surgical site infections (SSIs) in patients who underwent preoperative skin antisepsis with chlorhexidine-based formulations, compared with patients treated with iodine-based formulations. 3 The authors raise an interesting point, suggesting that the effectiveness of chlorhexidine-based formulations may be attributable to alcohol rather than to chlorhexidine.…”

SURGICAL SITE INFECTIONS; CULTURE & SENSITIVITY PATTERN OF MICRO-ORGANISMS ISOLATED IN A TERTIARY CARE HOSPITAL

“…Additionally emergence of anti-microbial resistance among the common organisms to conventional antibiotics especially in developing countries due to their irrational practices made the treatment of this seemingly easy condition more difficult. 4,9 The inoculum size, virulence and invasive capability of the organisms have been reported to influence the risk of infection. Moreover, the physiological state of the tissue in the wound and immunological integrity of the host also has equal importance in determining occurrence of infection.…”