Reduction of surgical site infection using a microbial sealant: A randomized trial

Abstract

Surgical site infection is a major cause of mortality and morbidity. We have explored the use of a microbial sealant applied before the surgical incision to reduce surgical site infection. We conducted a prospective, randomized, controlled clinical trial to determine the efficacy of a cyanoacrylate sealant in patients undergoing coronary artery bypass grafting. Both left and right long saphenous veins were harvested in individual patients below the knee if 3 or more lengths of vein were required. The sealant (Kimberly-Clark InteguSeal, Roswell, Ga) was applied to 1 leg chosen randomly, and the other leg was prepared in a conventional fashion. Microbiological swabs from the leg wounds were taken at 5 days, and wounds were assessed according to the Southampton score at 30 days by 2 blinded observers. The baseline characteristics of the treated and untreated legs were similar because the procedure was conducted on each individual patient. The study was terminated at 47 patients after review. Patients in whom the sealant was used had 1 (2.1%) wound infection, and there were 12 (25.5%) wound infections in the conventionally prepared leg (P=.001). There were 13 positive cultures from the treated leg and 22 positive cultures from the untreated site. The microbial skin sealant applied immediately before the incision significantly reduced the rate of surgical site infection. There was no sensitivity or adverse reaction after application. The treatment was easily integrated with existing routine preoperative procedures. Microbial sealant may thus be a useful addition to a multimodal approach to minimize surgical site infection.