Outcomes of an Intraoperative Povidone-Iodine Irrigation Protocol in Spinal Surgery for Surgical Site Infection Prevention

Abstract

Study Design: This was a retrospective observational study. Objective: The aim of this study was to evaluate the efficacy of our new protocol for preventing postoperative surgical site infection (SSI) following spinal surgery. Summary of Background Data: SSI following spinal surgery is a serious postoperative complication. Several studies have recently assessed the effectiveness of wound irrigation with povidone-iodine (PVP-I) for SSI prevention, but no consensus has been reached as to how PVP-I should be used in clinical practice. We formed a PVP-I irrigation protocol focusing on the pharmacological properties of PVP-I. This study aimed to evaluate the efficacy and safety of our protocol for preventing SSI. Materials and Methods: All cases of spinal surgery at our hospital between October 2011 and September 2016 were retrospectively reviewed. The exclusion criteria were PVP-I allergy, prior surgical debridement for infection, and implant removal surgery. The patients were subdivided into those who had received normal saline irrigation after 90 seconds of 1% PVP-I pooling every 1.5 hours (study group) or only routine saline irrigation every 1.5 hours (control group). The study and control groups comprised of 177 and 146 patients, respectively. This study compared the rate of SSI with and without the use of the PVP-I irrigation protocol. Results: The SSI rates were 1.7% for the study group (3/177 patients) and 3.4% for the control group (5/146 patients), showing no significant statistical difference (P=0.32). There were no cases of deep SSI in the study group, whereas there were 4 cases in the control group. The deep SSI rate significantly decreased in the study group (P=0.027). No adverse events occurred in the study group. Conclusion: In this study, 90 seconds of 1% PVP-I pooling every 1.5 hours followed by saline irrigation demonstrated the effectiveness of our protocol for the prevention of postoperative deep SSI after spinal surgery.

Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy

“…Many studies have been conducted on wound irrigation during different types of surgery. For example, Onishi et al ( 22 ) showed that using saline wound irrigation and PI intraoperatively was associated with a reduced incidence of SSI following spinal surgery. Another study showed that using chlorhexidine gluconate wound irrigation when antibiotics were not given within 60 min pre-operatively was associated with a reduced incidence of SSI following cesarean section ( 23 ).…”

Operative site irrigation with povidone-iodine solution in spinal surgery for surgical site infection prevention: Can it be used safety?

“…Recently, 90 sec of 1% PVP-I pooling every 1.5 h followed by saline irrigation has been suggested to be safe for the prevention of postoperative deep SSI after spinal surgery. 14…”

“…There is limited data on the safety dose spectrum of PVI for spinal surgeries. [12][13][14] On the other hand, normal saline has the lowest toxicity, but it only dilutes and does not cleanse the contaminants. 13 We conducted the current randomized clinical trial aimed to evaluate the effect of wound irrigation with PVI and normal saline on infection rate, wound healing, fusion status and clinical outcomes of spinal surgery.…”

Impact of wound irrigation during laparoscopic appendectomy on surgical site infection in acute appendicitis: a multicenter retrospective analysis

“…Chlorhexidine irrigation in caesarean section did not signi cantly decrease SSI [16]. During spinal surgery, deep SSI was signi cantly reduced after surgery when irrigation was performed with PI at regular intervals during surgery [7]. Topical antibiotics are also applied to the surgical wound to reduce SSI.…”

“…To decrease the SSI rate, wound irrigation utilizing various materials are performed. Povidone-iodine (PI) irrigation during spinal surgery signi cantly reduced the SSI rate compared to saline irrigation [7]. In abdominal surgery, subcutaneous wound irrigation with 0.04% polyhexanide solution signi cantly reduced SSI [8].…”