Paint-Only is Equivalent to Scrub-and-Paint in Preoperative Preparation of Abdominal Surgery Site

Abstract

Conclusion: A paint with povidone-iodine by itself provides equal preoperative preparation of the abdominal wall as a scrub with povidone-iodine soap, followed by paint with povidone-iodine. Summary: The authors conducted a prospective randomized trial comparing scrub-and-paint with povidone-iodine soap followed by absorption with a sterile towel and subsequent paint with povidone-iodine versus surgical site preparation with paint only of povidone-iodine. The primary end point was wound infection at 30 days with wound infection defined as clinical signs of infection requiring therapeutic intervention. Excluded patients included those with active infection at the time of operation, known sensitivity to iodine, neutropenia, or insertion of prosthetic material during operation. Patients were randomized to a scrub-and-paint group or a paint only group with povidone-iodine. There were 115 patients randomized to the scrub-and-paint arm and 119 to the paint only arm of the trial. Patients were well matched with respect to surgical co-morbidities, age, operative time, drains, surgical procedure, and prophylactic antibiotic use. There were 12 wound infections in the scrub-and-paint patients (10%) and 12 wound infections in the paint only patients (10%). Comment: These data apply only to clean and clean-contaminated cases that do not involve placement of a prosthetic device. While the data are interesting, they do not provide guidance as to the proper surgical prep site technique for patients undergoing insertion of prosthetic grafts. The optimal surgical prep site technique with respect to insertion of prosthetic vascular grafts remains to be determined.