Abstract
BackgroundPreoperative skin antisepsis is an essential component of safe surgery. However, it is unclear how many antiseptic paints are needed to eliminate bacteria prior to incision. This study compared microbial skin counts after two and three antiseptic paints.MethodsWe conducted a prospective cohort study in non-emergency patients receiving a cardiac/abdominal surgery with standardized, preoperative skin antisepsis consisting of an alcoholic compound and either povidone iodine (PI) or chlorhexidine (CHX). We obtained three skin swabs from the participant’s thorax/abdomen using a sterile template with a 25 cm2 window: After collection of the first swab prior to skin antisepsis, and once the second and third application of PI/CHX had dried out, we obtained a second and third swab, respectively. Our primary outcome was the reduction in microbial skin counts after two and three paints of PI/CHX.ResultsAmong the 239 enrolled patients, there was no significant difference in the reduction of mean square root-transformed microbial skin counts with three versus two paints (P = 0.2). But distributions of colony forming units (CFUs) decreased from paint 2 to 3 in a predefined analysis (P = 0.002). There was strong evidence of an increased proportion of patients with zero CFU after paint 3 versus paint 2 (P = 0.003). We did not identify risk factors for insufficient reduction of microbial skin counts after two paints, defined as the detection of > 5 CFUs and/or ≥ 1 pathogens.ConclusionsIn non-emergency surgical patients, three antiseptic paints may be superior to two paints in reducing microbial skin colonization prior to surgery.
Highlights
Surgical site infections (SSIs) are associated with increased morbidity, mortality and healthcare costs [1, 2]
Brief summary This prospective cohort study indicated that in nonemergency surgery patients, three consecutive antiseptic paints may be superior to two antiseptic paints in reducing microbial skin counts prior to surgery
Most SSIs after elective surgery may relate to residual, viable bacteria at the surgical site; preoperative skin antisepsis is a cornerstone of SSI prevention, coupled with routine antimicrobial prophylaxis to avoid regrowth of residual bacteria [3,4,5]
Summary
Surgical site infections (SSIs) are associated with increased morbidity, mortality and healthcare costs [1, 2]. Roth et al Antimicrobial Resistance and Infection Control (2020) 9:120 antimicrobial effectiveness of preoperative surgical site preparations may depend on both the antiseptic agent used and its specific application method, it is still unclear how many antiseptic paints are needed to adequately reduce microbial skin colonization at the surgical site: As of yet, no international, evidencebased recommendations exist on this topic, and experimental standards to compare and license preoperative application techniques for skin antisepsis are not established [6, 7]. We aimed to compare the effectiveness of two versus three antiseptic paints in reducing the microbial skin colonization at the surgical site. Preoperative skin antisepsis is an essential component of safe surgery. It is unclear how many antiseptic paints are needed to eliminate bacteria prior to incision. This study compared microbial skin counts after two and three antiseptic paints
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