Evaluation of Antiseptic Use in Plastic and Hand Surgery

Abstract

Despite the growing complexity of plastic surgical cases, antiseptics available for preoperative preparation do not always prove effective. In addition to the varied sites of plastic surgery, there is a likelihood of considerable contamination with microorganisms since surgical gloves are frequently punctured during surgical procedures. With an aim to find a solution to all of these problems, a study was conducted in 2 stages. First, antimicrobial effects on the normal flora of hands of 4 different surgical handwashing procedures, which consist of scrubbing with 7.5% povidone-iodine (PI) scrub by using the sponge/brush, 7.5% PI scrub alone, 0.5% benzalkonium chloride (BC) solution, and 0.1% BC solution, were compared. In the second stage, bacteriological samplings were obtained from fingertips of the operating team during the surgical procedure. At the end of the study, the following results were obtained: (1) scrubbing with 7.5% PI detergent by using a scrub sponge was significantly more effective than without using a scrub sponge (P < 0.05). (2) There was no statistically significant difference in scrubbing when povidone-iodine detergent and 0.5% benzalkonium chloride solution (P > 0.05) were compared. (3) At the end of the surgery lasting 1-5 hours, hands were found to be cleaner than previously washed hands for preoperative preparation, which was considered a consequence of the sustained effect of PI. (4) There was a statistically significant difference between the cultures taken from the gloves at the end of the operation and from the hands after the gloves were taken off (P < 0.01). At the end of the operation, the gloves themselves were found to be extremely dirtier than the hands inside them. As a conclusion, bacterial escape due to glove perforation occurs from outside of the glove to the inside, contrary to the generally accepted concept.

Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit?

“…28 However, care should be taken when applying CHG to avoid contact with the middle ear or areas adjacent to the eyes. [58][59][60] At Froedtert Hospital, patients who shower or cleanse with CHG prior to admission are instructed to avoid getting CHG in the eyes or external ear canal and to immediately rinse if they experience any burning or itching sensation following application. Is CHG bathing or cleansing an appropriate risk reduction strategy for young children or infants?…”

Influence of Povidone-Iodine Preoperative Showers on Skin Colonization in Elective Plastic Surgery Procedures

“…16 As in other studies, coagulase-negative staphylococci were recovered from the majority of the participants in the present study and were the predominant species of bacteria. 6,10,14 Colonies of fungi and enterobacteria were recovered in small amounts, and povidone-iodine showers did not significantly reduce skin colonization by these microorganisms.…”

“…The conventional concentration of povidone-iodine used in United States is 7.5%. 10,12,16 There are many skin antiseptics available commercially. However, the effectiveness of the products is usually investigated by in vitro techniques, as their activity on human skin is difficult to assess, for ethical reasons.…”

Role of Antiseptics in the Prevention of Surgical Site Infections

“…[2][3][4] Iodophors are effective against a wide range of microorganisms including Gram-positive and Gramnegative bacteria, some bacterial spores, yeast, other fungal forms, protozoa, and viruses such as HIV, and hepatitis B virus (HBV). 57 However, blood and serum proteins can inactivate PVP-I and prolonged or excessive application can cause systemic toxicity. 57 However, blood and serum proteins can inactivate PVP-I and prolonged or excessive application can cause systemic toxicity.…”