Efficacy of Surgical Preparation Solutions in Shoulder Surgery

Saltzman, Matthew D.; Nuber, Gordon W.; Gryzlo, Stephen M.; Marecek, Geoffrey S.; Koh, Jason L.

doi:10.2106/jbjs.h.00768

Cited by 277 publications

(192 citation statements)

References 10 publications

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“…First, our results are applicable only to shoulders because this was the only body part we studied; however, it is feasible that similar results would be found for other body regions because we think the ultrasound transmission gel or ultrasound probe can serve as a vector to transport bacteria from one area of skin to another. Second, our incubation period was only 5 days, and additional time may be required to cultivate certain pathogens that are particularly relevant to shoulder infections, such as Propionibacterium acnes [24]. Third, the effect of nonsterile gel on contamination was not assessed independent of sterile gel.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is paucity of data regarding infection risk and colonization related to musculoskeletal injections, recommendations of preparatory agents for surgical procedures can be extrapolated for this purpose. Saltzman et al [24] reported that combination chlorhexadine and alcohol-based preparations were superior to combinations of iodine and alcohol-based preparations at decreasing overall bacterial colonization in patients undergoing shoulder surgery. This trend also was consistent specifically to species of staphylococcus but not P acnes [24].…”

Section: Discussionmentioning

confidence: 99%

“…Saltzman et al [24] reported that combination chlorhexadine and alcohol-based preparations were superior to combinations of iodine and alcohol-based preparations at decreasing overall bacterial colonization in patients undergoing shoulder surgery. This trend also was consistent specifically to species of staphylococcus but not P acnes [24]. A systematic review and meta-analysis showed that fewer surgical site infections and greater costeffectiveness were associated with use of chlorhexadinebased solutions as opposed to iodine-based solutions [15].…”

Section: Discussionmentioning

confidence: 99%

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Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Sherman

Ferguson

Davis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Therapeutic musculoskeletal injections require a clean or sterile skin preparation to minimize the risk of infections. Ultrasound guidance for this procedure requires the use of transmission gel in proximity to the injection site, and its effect on maintaining sterility is unknown. Questions/purposes We asked: (1) Does sterile ultrasound transmission gel increase skin contamination during therapeutic orthopaedic injections? (2) Does nonsterile gel application result in increased contamination? (3) Does a manufacturer-approved ultrasound probe disinfecting agent in the form of 17.2% isopropanol and 0.28% diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride wipes adequately decontaminate the ultrasound transducer? (4) Does 70% isopropyl alcohol effectively decontaminate skin for administration of musculoskeletal injections? Methods Twenty-six healthy volunteers in an outpatient orthopaedic clinical setting were recruited. The subjects' skin was prepared to simulate a therapeutic intraarticular shoulder injection under ultrasound guidance. Four skin swabs for culture from each subject were taken: one sample before preparation with isopropyl alcohol, one sample after skin preparation, one after simulated injection procedure with sterile ultrasound transmission gel using the transducer, and one after mock procedure with nonsterile ultrasound transmission gel. In addition, samples were taken from the nonsterile ultrasound transmission gel and the transducer for culture analysis. Aerobic and anaerobic cultures were incubated during a 5-day period for bacterial species identification. Results Sterile ultrasound gel use results in an increase in skin contamination (odds ratio [OR], 9; 95% CI, 1.4-57.1; p = 0.005). Compared with sterile gel use, application of nonsterile gel did not increase contamination proportion (OR, 1.1; 95% CI, 0.8-1.7; p = 0.56). All cultures from nonsterile gel were negative. None of the samples cultured directly from the ultrasound probe were positive for bacteria (0%). Skin preparation with 70% alcohol decreased the proportion of contamination when compared with unprepared skin (OR, 21.0; 95% CI, 3.1-142.2; p = 0.001). Conclusions Use of ultrasound probes and transmission gel results in greater contamination in simulated intraarticular injections of the shoulder. As such, sterile preparation of the entire injection field, including the

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Sherman

Ferguson

Davis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Furthermore, when examining the studies used in the systematic review by Lee et al, 1 we see that the authors found only 3 studies (Saltzman et al, 3 Ostrander et al," and Veiga et al 5 ) that compared iodophore solutions that contain alcohol with chlorhexidine solutions that contain alcohol. In these studies, the outcomes measured were positive skin swab cultures and/or SSIs.…”

Section: The Importance Of Isopropyl Alcohol In Skin Preparation Solumentioning

confidence: 99%

“…3 The authors raise an interesting point, suggesting that the effectiveness of chlorhexidine-based formulations may be attributable to alcohol rather than to chlorhexidine. They include the following points in support of their hypothesis, which we appreciate having the opportunity to address below.…”

Section: Reply To Maiwald Et Al and Riccio Et Almentioning

confidence: 99%