Intraoperative Wound Irrigation Research Articles

Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy

Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking. To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution. The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial was a multicenter, 3-armed, randomized clinical trial. Patients and outcome assessors were blinded to the intervention. The clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis. Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure. The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition. Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups. In this study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting. drks.de Identifier: DRKS00012251.

Suspension of zinc oxide nanoparticles (ZnO-NP) as an intraoperative wound irrigation to prevent infection after fracture fixation

Background: Infection after fracture fixation (IAFF) associated with an implant in orthopaedic surgery is a feared complication, leading to non-union, loss of function, amputation, and even mortality and morbidity to the patient. A biofilm formation on the implant surface increases the difficulty of treatment. Therefore, surgical infection prevention with an effective antiseptic solution is required. This study aims to reveal more about the antibacterial effect of ZnO-NP suspension, particularly Staphylococcus aureus and its biofilm, in preventing surgical infection. Method: An in vitro experimental study with a posttest-only control group design was used to see the antimicrobial activity and inhibitory effect of Staphylococcus aureus biofilm formation between a 20% zinc oxide nanoparticle (ZnO-NP) suspension (20 mg/mL) compared to 0.3% povidone-iodine solution. The statistical result was tested using an independent t-test antibacterial activity. Meanwhile biofilm identification was evaluated using Mann-Whitney & Kruskal Wallis test for each group. Result: 20% ZnO-NP suspension has a minimum inhibitory concentration at 4 μg/mL and a minimum bactericidal concentration at 16 μg/mL, same as 0.3% povidone-iodine administration and its statistically significant (p-value 0.001). Minimum biofilm inhibitory concentration was seen at a concentration of 20% ZnO-NP suspension of 2 μg, while at higher doses, it showed lysis of bacterial cells. Conclusion: 20% ZnO-NP suspension is a promising solution for preventing surgical infection due to its antibacterial and antibiofilm effects.

Effectiveness of Gentamicin Wound Irrigation in Preventing Surgical Site Infection During Lumbar Spine Surgery: A Retrospective Study at a Rural Teaching Hospital in India.

Surgical site infections (SSIs) are an opposing result of surgery and account for the majority of healthcare-related infections worldwide. It is one of the most common complications associated with open-spine surgery and is associated with high rates of mortality and high demand for healthcare resources. Surgical site infections are the result of a variety of reasons, which is why a range of prevention strategies have been proposed. Intraoperative wound irrigation (IOWI) is a simple procedure that involves moving a solution through an open wound to help hydrate the tissue. It is a type of prophylactic wound irrigation. It removes and dilutes bodily fluids, bacteria, and cellular debris. It may also act as a bactericidal agent when used with antibiotics and antiseptics. To evaluate the incidence of SSIin lumbar spine surgeries by comparing IOWI with normal saline containing gentamicin (NS-G) and normal saline (NS) alone. A hospital-based retrospective study was conducted among 40 patients who underwent elective lumbar spine surgery at the Department of Orthopaedics, RL Jalappa Hospital Centre, Kolar, Karnataka, India. Out of the total participants enrolled, 60% were males and 40% were females. There was no statistically significant difference found between mean age, mean BMI, mean hemoglobin level, mean WBC counts, and mean fasting blood sugar (FBS) levels among both groups. The overall prevalence of SSI among patients was 25%. In Group A (NS-G), the prevalence of SSI was 15%, and in Group B (NS), it was 35%. In total, 17.5% of study participants had superficial SSI, while 7.5% had deep SSI. Gentamicin, an aminoglycoside antibiotic, is bactericidal and efficient against gram-positive organisms likeStaphylococcus, the most frequent pathogen causing SSI in spine surgery. During lumbar spine surgery, IOWI with saline and gentamicin before closure is more effective in preventing SSI than simple saline irrigation.

Intraoperative Wound Irrigation for Prevention of Surgical Site Infections After Abdominal Surgery

Objectives: To compare the frequency of surgical site infections after abdominal surgery with and without intraoperative irrigation of the surgical wounds.
 Methodology: This randomized controlled trial was performed in general surgery department, PAF Hospital, Islamabad from 10th August 2022 to 9th May 2023. A total of 520 patients undergoing abdominal surgeries of any gender between the ages of 15–70 years were included. Patients were randomly divided in two groups on the basis of non-probability, consecutive sampling. The participants included in the group-A did not receive any intraoperative wound irrigation. The participants in the Group-B received intraoperative wound irrigation with antiseptic solution i.e., povidone-iodine in solution. Each patient was followed up respectively on 7th, 21st and 30th days postoperatively to observe surgical site infection. Chi square test was applied to compare SSI percentage between two groups. P-value of less than 0.05 was taken as significant.
 Results: Mean age was 39.87±6.93 years in group-A and 37.67±7.56 years in Group-B. Out of 520 patients, 344 (66.15%) were males and 176 (33.85%) were females. Surgical site infection after abdominal surgery without intraoperative irrigation was found to be 34 (13.08%) and surgical site infection after abdominal surgery with intraoperative irrigation was 12 (4.62%), hence statistically significant (p-value = 0.0007).
 Conclusion: This study concluded that intraoperative wound irrigation is effective to prevent the surgical site infections after abdominal surgery.

Novel Intra- Operative Wound Irrigation Solution to Manage Infection Prevention in Patients Undergoing Primary Joint Arthroplasty: Retrospective Review of a Case Series of 308 Patients

Introduction Periprosthetic joint infection (PJI) after total hip and total knee arthroplasty is a devastating complication that is known to be associated with costly, resource-intensive interventions that place a significant burden on the US healthcare system. Estimated average hospital costs to treat female patients with PJI after total knee arthroplasty (TKA) or total hip arthroplasty (THA) in 2018 was $27,307, and $32,956 respectively. While the average costs to treat male patients with PJI after TKA or THA was $27,097 and $33,090 respectively. One strategy aimed at preventing PJI after total joint arthroplasty is the use of an intra-operative wound irrigation with an antiseptic solution. This retrospective case review was conducted to assess the incidence of PJI after using a novel wound antiseptic irrigation solution in patients undergoing primary TKA and THA. Methods The CDC defines surgical site infections, (SSI) as infections that occur after the surgery. The infections are further categorized as superficial involving the skin, or deep tissue. These infections are then divided into; superficial incisional SSI, deep incisional SSI, and organ-space SSI. In a study by Kannan et al., SSIs are more commonly seen in patients with more comorbidities. A consecutive series of 308 high-risk patients undergoing primary TKA or THA between January 4, 2021 and August 30, 2021, in whom Prontosan® Wound Irrigation Solution (B. Braun Medical Inc./ Innovice LLC), containing 0.1% Betaine, a surfactant, and 0.1% Polyhexanide (PHMB) was added to the intra-operative procedure, were evaluated for its impact on the incidence of PJI. The CDC’s Surgical Care Improvement Project, (SCIP) guidelines are standard of care and followed with each surgical procedure. The CDC recommends using antimicrobial prophylaxis at a time before skin incision such that the antibiotic concentration reaches the minimum bactericidal concentration at the time of skin incision, Berríos-Torres SI, et al. All data were prospectively submitted to the American Joint Replacement Registry (AJRR) was retrospectively analyzed to measure the incidence of postoperative infection. Results Primary TJA was performed on 308 patients; of these 10 patients were bilateral TKA (205 TKA procedures and 113 THA procedures). The use of Prontosan® Wound Irrigation Solution was associated with zero (0%) incidence of postoperative infection in this population of patients during a 90-day episode of care, nor at any time postoperatively. CMS defines total joint arthroplasty codes as a major surgery, and encounters or procedures within 90 days of the initiating procedure are included in the 90-day episode of care. No patients were lost to follow-up. Conclusion There was no incidence of PJI uncovered in this retrospective analysis. Adding Prontosan® Wound Irrigation Solution to the intra-operative protocol, contributed to the absence of PJI in this population and potentially avoided 1.74 female and 1.34 male TKA as well as .95 female and .75 THA resulting in total hospital-avoided costs of $83,824 and $56,126, respectively totaling $139,950.

Suspension of zinc oxide nanoparticles (ZnO-NP) as an intraoperative wound irrigation to prevent infection after fracture fixation

Background: Infection after fracture fixation (IAFF) associated with an implant in orthopaedic surgery is a feared complication, leading to non-union, loss of function, amputation, and even mortality and morbidity to the patient. A biofilm formation on the implant surface increases the difficulty of treatment. Therefore, surgical infection prevention with an effective antiseptic solution is required. This study aims to reveal more about the antibacterial effect of ZnO-NP suspension, particularly Staphylococcus aureus and its biofilm, in preventing surgical infection. Method: An in vitro experimental study with a posttest-only control group design was used to see the antimicrobial activity and inhibitory effect of Staphylococcus aureus biofilm formation between a 20% zinc oxide nanoparticle (ZnO-NP) suspension (20 mg/mL) compared to 0.3% povidone-iodine solution. The statistical result was tested using an independent t-test antibacterial activity. Meanwhile biofilm identification was evaluated using Mann-Whitney & Kruskal Wallis test for each group. Result: 20% ZnO-NP suspension has a minimum inhibitory concentration at 4 g/mL and a minimum bactericidal concentration at 16 g/mL, same as 0.3% povidone-iodine administration and its statistically significant (p-value 0.001). Minimum biofilm inhibitory concentration was seen at a concentration of 20% ZnO-NP suspension of 2 μg, while at higher doses, it showed lysis of bacterial cells. Conclusion: 20% ZnO-NP suspension is a promising solution for preventing surgical infection due to its antibacterial and antibiofilm effects.

ROUTINE SURGICAL ANTISEPTIC AGENTS ARE INEFFECTIVE IN THE ERADICATION OF TYPICAL PJI BIOFILM FORMED ON ORTHOPAEDIC IMPLANT MATERIAL IN VITRO AND THE ABSENCE OF AN ANTISEPTIC NEUTRALIZATION STAGE GIVES THE FALSE IMPRESSION OF EFFICACY

Prosthetic joint infection (PJI) is a serious complication following joint replacement. Antiseptic solutions are often used for intraoperative wound irrigation particularly in cases of revision for PJI. Antiseptic irrigation is intended to eradicate residual bacteria which may be either free floating or in residual biofilm although there is no clear clinical efficacy for its use. Also, reviewing the scientific literature there is discordance in in vitro results where some studies questions antiseptic efficacy whilst others suggest that even at low concentration antiseptic agents are effective at eradicating bacterial biofilms.The aim of this in vitro study was to establish the efficacy of undiluted antiseptic agents at eradication of a typical PJI forming biofilm and determine the importance of an antiseptic neutralisation step in this assessment.Mature Staphylococcus epidermidis biofilms grown on TiAl6V4 discs were submerged in chlorohexidine (CHL) gluconate 4%, povidone-iodine (PI) 10% or phosphate-buffered saline (PBS) control solution. The discs were then rinsed, the biofilm bacteria suspended in solution using sonication and vortexing, and the viable count (CFU/ml) of the bacterial suspensions determined. The rinse/suspension solution was either (a) PBS or (b) Dey-Engley neutralization broth (NB).When PBS was used to rinse/suspend the biofilm a highly significant, 7.5 and 4.1, mean log reduction in biofilm vitality was observed from the control, for CHL 4% and PI 10%, respectively. However, when NB was the rinse/suspension solution the apparent antiseptic biofilm eradication efficacy was replaced with a statistically significant but clinically irrelevant less the one log-reduction in biofilm vitality.Clinical antiseptic agents are ineffective at eradicating S. epidermidis biofilm in an in vitro PJI model and absence of a neutralisation step gives the false impression of efficacy. Antiseptics alone are an ineffective treatment for biofilm related PJI and no substitute for meticulous debridement.

Suspension of Zinc Oxide Nanoparticles (ZnO-NP) as an Intraoperative Wound Irrigation to Prevent Infection After Fracture Fixation

Suspension of Zinc Oxide Nanoparticles (ZnO-NP) as an Intraoperative Wound Irrigation to Prevent Infection After Fracture Fixation

THE PROCESS OF WOUND HEALING IN POST SECTIO CAESAREA PATIENTS USING NORMAL SALINE (0.9%) AND POVIDONE-IODINE (10%) IRRIGATIONS: A COMPARATIVE STUDY

Surgical Site Infection (SSI) is a complication after surgery, and one of the causes is the use of intra-operative irrigation fluids. The most common irrigation fluid was 0.9% Normal Saline and 10% Povidone-Iodine in several hospitals in Indonesia. However, the difference in composition has not been observed for its effect on wound healing. This study aimed to determine the difference in using 0.9% Normal Saline and 10% Povidone-Iodine for irrigation in the wound healing process for post-cesarean patients. The research design used is a descriptive comparative study with ex post facto approaches. Due to the COVID-19 pandemic, researchers changed the data collection method from direct observations to analyzing secondary data post-cesarean surgery data in 2019. The study was conducted in a referral hospital in West Java Province, Indonesia. The sampling used non-probability sampling with a purposive sampling technique. The sample was 440 patient medical records. These records consisted of 0.9% Normal Saline irrigation fluid, 140 respondents, and 10% Povidone-Iodine irrigation fluid, 300 respondents. The chi-square analysis showed significant differences in the two types of intra-operative wound irrigation (0.9% Normal Saline and 10% Povidone-Iodine) with a wound healing process (P-value = 0.021). The distribution frequency showed that the infection of 0.9% Normal Saline fluid was 5% of the 133 respondents, and 10% Povidone-Iodine was 12% out of 300 respondents. The study results showed that 0.9% Normal Saline and 10% Povidone-iodine could be used for intra-operative wound irrigation with different characteristics and compositions that impact the postoperative wound healing process. There is a need for further research to do a direct observation to test the effectiveness of two types of irrigation fluids from intra-operative to postoperative and assess other influencing factors.

Surgical site infection prevention in abdominal surgery: is intraoperative wound irrigation with antiseptics effective? Protocol for a systematic review and meta-analysis

IntroductionSurgical site infection (SSI) after laparotomy still represents the most frequent postoperative complicationin abdominal surgery. The effectiveness of reducing SSI rates by intra-operative irrigation of the incisional wound with antiseptic...

Prevention of Surgical Site Infection Following Open Spine Surgery: The Efficacy of Intraoperative Wound Irrigation with Normal Saline Containing Gentamicin Versus Dilute Povidone-Iodine

Intraoperative wound irrigation (IOWI) is an important step in preventing surgical site infection (SSI). This study compared the effectiveness of saline with gentamicin versus povidone-iodine as IOWI solutions in preventing SSI in open spine surgery. It is a prospective comparative study. Patients who had non-instrumented open spine surgery were randomized into two groups. Group A and B patients had their surgical wounds irrigated with saline containing gentamicin solution and dilute povidone-iodine solution, respectively. Both groups were assessed for the occurrence of SSI. A total of 80 patients, divided into two groups of 40 each completed the study. Overall, the SSI rate was 17.5% for patients in the normal saline containing gentamicin group (A) and 2.5% for those in the dilute povidone-iodine group (B), this difference was statistically significant (p=0.025). The cervical and thoracic spine regions have the same SSI rate (7.1% and 0% respectively) in both groups. However, in the lumbosacral region, the SSI rate was 31.6% in A and 0% in B, this was statistically significant (p=0.006). The isolated organisms in patients with SSI were staphylococcus species (42.86% of SSI in A and 0% in B) and pseudomonas species (42.86% of SSI in group A and 100% in group B), and this difference was profound in the lumbosacral spine region (p=0.008). Intraoperative wound irrigation with 3.5% dilute povidone-iodine solution is more efficacious in preventing SSI and has wider microbial coverage compared to normal saline containing gentamicin solution as IOWI fluid in non-instrumented open spine surgery.

Implementation of intraoperative wound irrigation with aqueous 10% povidone-iodine and triclosan-coated sutures is not effective for reducing the incidence of incisional surgical site infection after major hepato-biliary-pancreatic surgery in patients with preoperative biliary drainage.

Patients who receive preoperative biliary drainage (PBD) and biliary reconstruction are most at risk for incisional surgical site infection (SSI) in major hepatobiliary-pancreatic (HBP) surgery. We evaluated 72 patients with PBD who underwent major HBP surgery and received intraoperative wound irrigation (IOWI) with saline and standard sutures between March 2014 and March 2017 (Cohort 1) and 63 patients with PBD who underwent major HBP surgery and received IOWI with aqueous 10% povidone-iodine and antibacterial sutures between June 2019 and February 2022 (Cohort 2). We compared the incidence of incisional SSI between the two cohorts. Twenty-seven (20.0%) of 135 patients developed incisional SSIs. The rate of current smoking was more frequent in patients who developed incisional SSIs than in those who did not (37.0% vs. 14.8%, p=.012). A total of 18 (25%) of 72 patients developed incisional SSI in Cohort 1, and nine (14.3%) of 63 developed incisional SSI in Cohort 2. Cohort 2 had a 10% lower incidence of incisional SSI than Cohort 1, a nonsignificant difference (p=.09). The implementation of IOWI with aqueous 10% PVP-I and antibacterial sutures failed to significantly reduce the incidence of incisional SSI in comparison to IOWI with saline and standard sutures in major HBP surgery.

Is There an Association between Intra-Operative Detection of Pathogens in Subcutaneous Tissue and Surgical Site Infections? Results from a Prospective Study.

Background: Surgical site infections (SSIs) are a common complication in visceral surgery. Pathogens causing SSIs vary depending on the type of surgery. Patients and Methods: Within the scope of the Reduction of Postoperative Wound Infections by Antiseptica (RECIPE) trial we analyzed the pathogens cultured in intra-operative, subcutaneous swabs and in swabs from SSI in a single-center, prospective, randomized controlled study. Definition of SSI complied with the criteria of the U.S. Centers for Disease Control and Prevention (CDC). Results: The overall rate of SSI was 28.2% in 393 patients. Colorectal surgery was performed in 68.2% of elective laparotomies. Pathogens were more often detected in intra-operative subcutaneous swabs in patients who developed SSIs than in patients who did not develop SSIs (64.4% vs. 38.0%; p < 0.001). Enterococci were found in 29.1% of intra-operative swabs in patients with SSIs, followed by Escherichia coli in 15.5%. A higher rate of Enterococcus faecium was found in patients with anemia versus those without anemia (9.2% vs. 2.3%; p = 0.006) and in patients who smoked versus those who did not (11.8% vs. 3.6%; p = 0.008). A positive subcutaneous swab (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.47-4.29; p = 0.001), pre-operative anemia (OR, 1.84; 95% CI, 1.08-3.13; p = 0.016), and renal insufficiency (OR, 2.15; 95% CI, 1.01-4.59; p = 0.048) were risk factors for SSIs. Conclusions: There is an association between the intra-operative detection of pathogens in subcutaneous tissue and the development of SSIs in visceral surgery. The most prevalent pathogens causing SSIs were enterococci and Escherichia coli. More efforts are justified to reduce subcutaneous colonization with pathogens, for example by using intra-operative wound irrigation with polyhexanide solution. This trial is registered at www.ClinicalTrials.gov (ID: NCT04055233).

Effect of Intraoperative Wound Irrigation with Topical Phenytoin on Postoperative Seroma Formation after Modified Radical Mastectomy

Effect of Intraoperative Wound Irrigation with Topical Phenytoin on Postoperative Seroma Formation after Modified Radical Mastectomy

The impact of surgical site infection\u2014a cost analysis

PurposeSurgical site infection (SSI) occurs in up to 25% of patients after elective laparotomy. We aimed to determine the effect of SSI on healthcare costs and patients’ quality of life.MethodsIn this post hoc analysis based on the RECIPE trial, we studied a 30-day postoperative outcome of SSI in a single-center, prospective randomized controlled trial comparing subcutaneous wound irrigation with 0.04% polyhexanide to 0.9% saline after elective laparotomy. Total medical costs were analyzed accurately per patient with the tool of our corporate controlling team which is based on diagnosis-related groups in Germany.ResultsBetween November 2015 and May 2018, 456 patients were recruited. The overall rate of SSI was 28.2%. Overall costs of inpatient treatment were higher in the group with SSI: median 16.685 €; 19.703 USD (IQR 21.638 €; 25.552 USD) vs. median 11.235 €; 13.276 USD (IQR 11.564 €; 13.656 USD); p < 0.001. There was a difference in surgery costs (median 6.664 €; 7.870 USD with SSI vs. median 5.040 €; 5.952 USD without SSI; p = 0.001) and costs on the surgical ward (median 8.404 €; 9.924 USD with SSI vs. median 4.690 €; 5.538 USD without SSI; p < 0.001). Patients with SSI were less satisfied with the cosmetic result (4.3% vs. 16.2%; p < 0.001). Overall costs for patients who were irrigated with saline were median 12.056 €; 14.237 USD vs. median 12.793 €; 15.107 USD in the polyhexanide group (p = 0.52).ConclusionSSI after elective laparotomy increased hospital costs substantially. This is an additional reason why the prevention of SSI is important. Overall costs for intraoperative wound irrigation with saline were comparable with polyhexanide.

The Role of Intra-Operative Wound Irrigation with Normal Saline in Reduction of Surgical Site Infection in Gynecological Surgeries

Objective: To evaluate the efficacy of intra-operative wound irrigation with normal saline in reducing surgical site infections in gynaecological surgeries.&#x0D; Methods: It is a prospective cohort study carried out at Obstetrics and Gynaecology Department, Pak-Emirates Military Hospital, Rawalpindi from 1st November 2019 to 30th April 2020. A total of 400 patients undergoing abdominal surgery for gynecological reasons were recruited by consecutive non-probability technique. Patients with known comorbidities were excluded. Participants of study were allocated cohort and control groups at the end of the surgery after closing the abdominal fascia. In cohort group, the subcutaneous soft tissue was irrigated with 1000 ml of Normal saline solution before skin closure and sterile dressing. No intra-operative wound irrigation was performed in the control group. The primary and secondary endpoint measures (SSI up to 10th Post-Operative day) and (SSI up to 30th Post-Operative day) respectively, were assessed clinically.&#x0D; Results: The study included 400 patients, with 200 in the cohort group and 200 in the control group with Mean Age of (Mean ± SD) 33.6±8.1 years. Majority of the patients had Pre-Op Hemoglobin of &gt;11 g/dl (216)54%. Most common surgeries were Caesarean section (324)81% and Hysterectomy (40)10%. Maximum surgeries were performed between 30-30 min (312)78% with mean hospital stay of (Mean ± SD) 2.9±0.5 days. Analysis of the results showed that Intra-operative wound irrigation with normal saline significantly lesser rate of postoperative SSIs in comparison to no irrigation at both primary outcome measure that was SSI at 10th Post-operative day (POD)(RR=0.417, 95 % CI [0.15;1.161]) and secondary outcome measure that was SSI at 30th POD(RR=0.286, 95 % CI [0.060;1.359]).&#x0D; Conclusion: Intra-operative wound irrigation with Normal Saline decreases the risk of SSI by 58.3% (AR) at 10thPOD and by 71.4% (AR) at 30th POD in otherwise healthy women with no comorbidities.

Does povidone-iodine application in surgical procedures help in the prevention of surgical site infections? An updated meta-analysis.

IntroductionSurgical site infections (SSIs) occur after an operative procedure and can range from superficial to deep wound infections. The World Health Organization (WHO) and the Centers for Disease Control (CDC) have proposed guidelines recommending measures to prevent SSIs. Intraoperative measures are largely focused on decontamination of the skin and intraoperative wound irrigation using soap and antiseptics and are simple, efficient, and cost-effective measures to reduce SSIs. Povidone-iodine (PVI) is a topical antiseptic widely used for the reduction of SSIs.AimA meta-analysis was conducted to determine the efficacy of preoperative or intraoperative use of PVI from randomized controlled trials (RCTs).Material and methodsA systematic literature review was conducted using MEDLINE and Central databases for RCTs that involved PVI application versus saline or no treatment control groups across various surgical categories. The primary outcome was SSI or post-operative wound infections. A random-effects model was used to calculate the pooled risk ratio and subgroup analyses were performed.ResultsA total of 59 RCTs were included in the meta-analysis with information from 20,497 patients. A reduction in overall SSI incidence was found (RR = 0.70, 0.60–0.80, p = 0.0002, I2 = 44%). Subgroup analyses showed that the comparator treatment and type of procedure did not modify the effect of PVI on SSI incidence. However, inconsistent results on SSI incidence were obtained when the data were stratified by PVI application method and surgery category.ConclusionsThe results of the meta-analysis provide support for the preoperative or intraoperative use of PVI in decreasing the incidence of SSI.

Intra-operative wound irrigation with ceftriaxone does not reduce surgical site infection in clean neurosurgical procedures

Background The spectrum of post-operative infections in neurosurgical practice includes scalp infection, bone flap osteomyelitis, meningitis and intracranial abscesses and is associated with significant morbidity and mortality. There is a wide variation across neurosurgical centres in the use of perioperative antibiotic prophylaxis. The aim of this study was to determine whether intraoperative wound irrigation with ceftriaxone provides additional prevention of surgical site infection (SSI) in patients already receiving the drug parenterally. Methods This was a prospective randomized clinical study of patients 18 years and above scheduled for clean neurosurgical procedures and assigned to either study or control group using table of random numbers. Both groups had parenteral ceftriaxone at the induction of anaesthesia and for 24-h post-operation. In the study group, there was intra-operative wound irrigation with a ceftriaxone-in-normal saline solution while the wound in the control group was irrigated with only normal saline. Clinical and or laboratory evidence of SSI was used as the outcome measure. Results One hundred and thirty-two patients aged 18 years and above were recruited for this study. There were 66 patients in each group. The overall frequency of SSI was 2.27% (3 out of 132). The frequency in the ceftriaxone group was 3% (2 out of 66) while that in the control group was 1.5% (1 out of 66). These values were not significantly different (p = 1.00). There were four cases of wound edge necrosis, three of which developed SSIs. Conclusion In this study, intraoperative antibiotic irrigation did not confer additional benefit in the prevention of SSI in clean neurosurgical procedures in which prophylactic intravenous antibiotics were administered to the patient. Wound edge necrosis was the most significant but preventable risk factor for the development of SSI in the setting of this work.

Just add water? Chlorhexidine's antimicrobial properties are minimally affected by dilution in saline compared to water.

Dilute chlorhexidine gluconate (CHG) in sterile water is an antiseptic solution approved for intraoperative wound irrigation by the United States Food and Drug Administration. In practice, however, CHG is commonly diluted with normal saline, which can result in its precipitation potentially reducing the antimicrobial effect. The purpose of this study was to determine if the antimicrobial properties of CHG are reduced after dilution with normal saline compared to sterile water. Sterile paper disks were placed into undiluted 4% CHG (positive control), 0.05% CHG in sterile water, 0.05% CHG in normal saline, or normal saline alone (negative control) and then placed in triplicate onto the agar plates inoculated with Staphylococcus aureus. After incubating at 37°C for 24h, the diameter of the zone of inhibition around each disk was measured. The mean zone of inhibition for 4% CHG, 0.05% CHG in sterile water, 0.05% CHG in normal saline, and normal saline alone was 24 ± 0.6mm, 16 ± 0.9mm, 14 ± 0.5mm, and 0 ± 0mm, respectively (p < 0.01). The zone of inhibition for dilute CHG in normal saline was on average 2.5mm less (95% CI 1.7-3.2mm) than that of CHG in sterile water. Dilute CHG in normal saline, versus sterile water, retained its antimicrobial activity with a small reduction in the zone of inhibition. Surgeons and scientists should be aware of the interaction between normal saline and CHG. Future scientific studies need to control for what solution is used for dilution.

Role of intraoperative wound irrigation with antibiotics in reducing surgical site infection in patients undergoing contaminated and dirty midline laparotomy surgical wound: a pilot study

Background: This study was carried to assess the effect of antibiotic wound irrigation in reducing the surgical site infection (SSI) in the patients undergoing midline laparotomy with contaminated and dirty surgical incision wound.Methods: All patients operated with class-IV- dirty and class III (contaminated) abdominal operative wound according to CDC (Centre for Disease Control and Prevention) were included in this pilot study. Study patients were divided into antibiotic irrigation group and control group. In control group, after rectus sheath closure, the wound was irrigated with 100 mL of normal saline before the skin closure. In antibiotic irrigation group, after rectus sheath closure, the wound was irrigated with Ceftriaxone (10 mL) and Metronidazole (100 mL). Incidence of SSI, degree of SSI and length of hospitalization were compared between two groups.Results: A total of 40 patients were included in the study, 20 in each group. Both the groups were comparable with respect the age, gender, co-morbidities and class of surgical wound. The incidence of SSI was lesser [10% versus 35%; p=0.06] in the antibiotic irrigation group compared to control group. However, the difference was not statistically significant. The length of hospitalization between the groups were comparable [13.5 versus 14.7 days; p=0.74]. The pain score was also not significantly different between the two groups.Conclusions: On comparing to saline irrigation, antibiotic irrigation in patients with contaminated and dirty operative wound results in a lesser SSI with comparable hospital stay and postoperative pain. However, the difference was not statistically significant.