Preoperative Skin Preparation Research Articles

A novel device for preoperative skin preparation to reduce the risk of injury and surgical site infection during lower limb surgery.

Surgical site infection (SSI) continues to be a feared complication of surgery but especially orthopaedic surgery where a superficial SSI has been estimated to add nine days to the hospital stay and an average of £2500 to the cost. Despite the efficacy of all skin preparation agents being maximal at around 10 minutes no current system, apart from the double prep method attributed to Sir John Charnley, allows adequate control of bacteria. Current techniques of skin preparation require lifting of the limb with an associated risk of injury to theatre operatives. In order to provide for longer duration of contact, potentially better antisepsis and to remove the dangers inherent in lifting the limb we developed a novel system for limb antisepsis prior to surgery. To demonstrate efficacy we performed a single blind randomised controlled trial powered to demonstrate non-inferiority. We demonstrated a significant benefit of the device in terms of bactericidal effect. Whilst only recently entering full production, we would recommend the system as a significant improvement over current techniques of limb antisepsis.

Skin preparation for abdominal surgery

Surgical site infections (SSI) are a public health issue. The purpose of this review is to review the literature on methods of pre-operative skin preparation for the prevention of SSI in abdominal surgery. In order to obtain the best level of evidence, only meta-analyses and randomized controlled clinical trials were selected from the Cochrane Library and PubMed databases. High-powered non-randomized studies were included when results were not available for the questions asked. The primary endpoint was the rate of SSI within 30 days. Analysis of the 20 selected studies suggested that hair removal in the operative field is not recommended except when it interferes with surgery; in this case, hair clipping or chemical depilation is recommended and shaving should be banned. For the pre-operative shower, the choice of a detergent product with or without antiseptic does not seem to matter, and there were no published data on the required number of showers or the interval before surgery. Application of an alcohol-based solution to the operative field for cutaneous disinfection is recommended; the products used seem to be equivalent, and there is no need for pre-operative detergent scrubbing. There is no strong evidence to recommend adhesive plastic drapes for clean or contaminated surgery. Some recommendations on skin preparation before abdominal surgery to reduce the rate of SSI are based on a high level of evidence. Other recommendations such as the number and duration of pre-operative showers or use of adhesive plastic skin drapes are less well supported.

Comparative clinical effectiveness of preoperative skin antiseptic preparations of chlorhexidine gluconate and povidone iodine for preventing surgical site infections in dogs

Contamination of surgical sites often resulting from inadequate surgical site preparation and poor asepsis is a common cause of surgical site infection (SSI) and postoperative complications. Standard practice ensuring preoperative skin disinfection helps to prevent the incidence of SSI. The choice of antiseptic therefore poses a serious counterbalance for the surgeon. This study was carried out to determine whether skin asepsis immediately prior to surgical site incision will reduce skin microbial burden that may potentiate the incidence of SSI and to compare the clinical effectiveness of chlorhexidine gluconate B.P 0.3%W/V, Cetrimide B.P 3.05 W/V (CG + Cetrimide) against povidone iodine 10% (PI) in pre-surgical skin preparation and asepsis in dogs. A total of 15 dogs were used for the study. Both side of each dog was used for the study, right side for CG + Certrimide and left side for PI; (n = 30). Aseptic agents’ chlorhexidine gluconate 0.3% and Cetrimide 3.0% and povidine iodine 10% were used as pre surgical scrub solutions prior to surgery. Swab samples were evaluated before scrubbing, 0, 30, 60 and 90 min after scrubbing. Percent reductions of bacterial colony forming units were determined for all site scrub techniques. Mixed-design ANOVA results revealed significant difference (P < 0.05) within groups and no significant difference (P > 0.05) in the disinfectant effects between groups treated with CG + Cetrimide and povidone iodine respectively across the various time periods. Changes in the mean bacteria count were observed to be equivalent using CG + Cetrimide and povidone iodine. It was concluded that there was no significant difference between CG + Cetrimide and PI in preoperative surgical skin preparations.

A Comparative Study for Pre-operative Skin Preparation - Shaving Versus Depilation Cream

Background: The use of depilatory creams was shown to be effective, atraumatic, non-toxic and could be self-administered. Depilatory creams could be used safely on granulating wounds and did not give rise to bacterial growth.Subjects and Methods:A prospective, randomized study was carried out to compare the effect of pre-operative shaving with chemical depilation on wound infection in 100 patients.Results:It was shown that depilatory creams saved time for pre- operative preparation and had an advantage in areas where shaving was difficult. Their use was associated with significance.Conclusion: The depilatory cream has an advantage in areas which are difficult to shave or if the patient is scheduled to undergo diagnostic procedures and operations in the same area in close succession

Frequency of Infection in Cervical Lymph Node Biopsy Site using Chlorhexidine and Povidine Iodine

Abstract:Background: Lymph node are located throughout the lymphatic system, they are concentrated in certain areas of the body including head and neck. Cervical lymph nodes are lymph nodes found in the neck. Of the 800 lymph nodes in the human body, 300 are in the neck. Cervical lymph nodes are subject to several different pathological conditions including tumours, infection and inflammation.Methodology: The Povidine-iodine and chlorhexidine for preoperative skin preparation in cervical lymph node biopsy procedure were used in this study and patients were asked for follow up after a week. On follow up day their wounds were checked, assessed and withdraw all stiches and complications were recorded accordingly and analysed them. It was discussed and showed that which one of Povidine-iodine and chlorhexidine is best to use for preoperative skin preparation in cervical lymph node biopsy procedures to reduce surgical site infection and economical one.Results: Out of 150 patients, 46% (69) were males and 54% (81) were females that had cervical lymphadenopathy after skin preparation by chlorhexidine antiseptic solution showed frequency of infection in total of 150 patients 16.67% (25) were infected while the other 83.33%(125) were not infected. Out of 150 patients who were underwent cervical lymphadenopathy after using povidine iodine skin preparatory antiseptic solution, 42% (63) were males and 58% (87) were females and among those frequency of infection showed 44.67% (67) were infected while the others 55.33% (83) were not.Conclusion: Preoperative scrubbing of the patient’s skin with chlorhexidine–alcohol is better than scrubbing with povidone–iodine for preventing surgical-site infection after cervical lymph node biopsy.

Preoperative Skin Preparation with Chlorhexidine Alcohol and Povidone Iodine: A Comparative Study

Preoperative Skin Preparation with Chlorhexidine Alcohol and Povidone Iodine: A Comparative Study

Current treatments in periprosthetic shoulder infections

Management of shoulder arthroplasty infections can be challenging. The most common organisms that are isolated from shoulder arthoplasty infections are Propionibacter acnes and Staphylococcus species. Treatment algorithms tend to be unclear, especially in the setting of unexpected positive cultures and in Propionibacter acnes infections, but they include antibiotic suppression, tissue debridement with retention of the prosthesis, one or two-stage prosthesis exchange, and resection arthroplasty. Prevention of infection is paramount, with the use of antibiotics and proper preoperative skin preparation. Our goal was to review the current literature in diagnosing and managing shoulder arthroplasty infections.

The role of antimicrobial sutures in preventing surgical site infection.

INTRODUCTION Healthcare associated infections (HCAIs) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant Staphylococcus aureus or emergent pathogens such as Clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (SSI), either in the UK, the EU or the US. SSI is one of the HCAIs, which are all avoidable complications of a surgical patient's pathway through both nosocomial and community care. METHODS This report is based on a meeting held at The Royal College of Surgeons of England on 21July 2016. Using PubMed, members of the panel reviewed the current use of antiseptics and antimicrobial sutures in their specialties to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in surgical practice may help in reducing reliance on antibiotics in infection prevention and control, especially in the perioperative period of open elective colorectal, hepatobiliary and cardiac operative procedures. The wider use of antiseptics includes preoperative showering, promotion of hand hygiene, (including the appropriate use of surgical gloves), preoperative skin preparation (including management of hair removal), antimicrobial sutures and the management of dehisced surgical wounds after infection. The meeting placed emphasis on the levelI evidence that supports the use of antimicrobial sutures, particularly in surgical procedures after which the SSI rate is high (colorectal and hepatobiliary surgery) or when a SSI can be life threatening even when the rate of SSI is low (cardiac surgery).

A randomized open-label controlled trial of chlorhexidine-alcohol vs povidone-iodine for cesarean antisepsis: the CAPICA trial

Identification of optimal surgical site antisepsis preparations may reduce cesarean-related surgical site infections. Two recently published investigations examined efficacy of chlorhexidine-alcohol and iodine-alcohol preparations. No previous randomized controlled trial has compared chlorhexidine-alcohol to povidone-iodine aqueous scrub and paint in reduction of cesarean-related surgical site infection. The purpose of the study was to determine if chlorhexidine-alcohol would result in fewer surgical site infections than povidone-iodine when used as skin antisepsis preparation prior to cesarean delivery. This study was a single-center pragmatic randomized controlled trial at an urban tertiary care institution to compare chlorhexidine-alcohol 26-mL single-step applicator to povidone-iodine aqueous scrub and paint 236-mL wet skin tray as preoperative skin antiseptic preparation for women undergoing cesarean delivery. Patients were eligible for study participation if they could provide informed consent in English or Spanish, were ≥18 years of age, did not have clinical chorioamnionitis, were unlikely to be lost to follow-up, and had no sensitivities to chlorhexidine, betadine, or iodine. Treatment was assigned by computer-generated simple 1:1 randomization immediately before skin preparation. The primary outcome was surgical site infection occurring within 30 days of cesarean delivery including ≥1 of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions. Analysis was by intent to treat. Categorical outcomes were compared using Fisher exact test. The Wilcoxon rank-sum test was performed for continuous outcomes. This trial was institutional review board approved and registered at ClinicalTrials.gov (NCT02202577). In all, 932 subjects (461 assigned to chlorhexidine-alcohol, 471 assigned to povidone-iodine) were randomized from February 2013 through May 2016. Rate of follow-up evaluation after 30 days was 99% (455) in the chlorhexidine-alcohol group and 97% (455) in the povidone-iodine group. Surgical site infection occurred in 29 (6.3%) of the chlorhexidine-alcohol group and 33 (7.0%) in the povidone-iodine group (P= .38). The rates of individual components of the primary outcome were as follows: superficial surgical site infection (4.6% v 5.5%; P=.55), deep surgical site infection (0.0% v 0.4%; P= .50), and endometritis (1.7% v 1.1%; P= .42) in chlorhexidine-alcohol vs povidone-iodine arms, respectively. All results were similar in per protocol analysis. Preoperative antiseptic skin preparation with chlorhexidine-alcohol 26-mL single-step applicator before cesarean did not result in less frequent surgical site infection when compared with povidone-iodine aqueous scrub and paint 236-mL wet skin preparation tray. Povidone-iodine should still be considered as acceptable for preoperative surgical site antisepsis for cesarean delivery.

A Comparitive Study of Chlorhexidine Alcohol versus PovidoneIodine for Pre-operative Skin Preparation

A Comparitive Study of Chlorhexidine Alcohol versus PovidoneIodine for Pre-operative Skin Preparation

Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis

Background: Surgical site infection remains substantial problems to surgeons and patients as it increases the morbidity, mortality, length of stay, hospital cost, rate of re-admission, and rate of re-surgery. This study aims to compare the use of chlorhexidine-alcohol versus povidone-iodine for preoperative skin preparation to prevent surgical site infection.Methods: The literature search was conducted through the PubMed database on November 2015. Included studies were RCTs with the year of publication up to 2015 which compared the use of chlorhexidine-alcohol versus povidone-iodine in its effectiveness reducing surgical site infection in adult patients. The quality of the study was assessed using Jadad Score. A meta-analysis was conducted in the included study to obtain a pooled estimate of the effect size. The evidence of heterogeneity and publication bias was also assessed.Results: Six RCTs with a total of 2,080 patients were included in the meta-analysis. It showed that the use of chlorhexidine-alcohol was associated significantly with fewer SSIs (pooled risk ratio=0.60 (95% CI=0.45-0.79)) and fewer positive skin culture results (pooled risk ratio, RR=0.38 (95% CI=0.28-0.51)) compared with povidone iodine.Conclusion: Preoperative skin antisepsis with chlorhexidine is more effective than povidone-iodine in preventing surgical site infection.

Benzoyl peroxide and clindamycin topical skin preparation decreases Propionibacterium acnes colonization in shoulder arthroscopy

Propionibacterium acnes is a gram-positive anaerobe that can lead to devastating postoperative shoulder infections. The objective of this study was to investigate whether a benzoyl peroxide and clindamycin preoperative skin preparation reduces the incidence of P. acnes colonization during shoulder arthroscopy. Sixty-five shoulder arthroscopy patients were prospectively enrolled. A skin culture specimen was taken at the preoperative visit from standard arthroscopic portal sites. Topical benzoyl peroxide 5% and clindamycin 1.2% (BPO/C) gel was applied to the shoulder every night before surgery. Skin culture was repeated in the operating room before preparation with chlorhexidine gluconate. Shoulder arthroscopy proceeded, with final culture specimens obtained from within the shoulder. P. acnes skin colonization remained similar to prior studies at 47.7% (31 of 65 patients.) With >1 application, BPO/C was 78.9% (15 of 19 patients) effective in eliminating P. acnes superficial colonization. With 1 application, it was 66.7% (8 of 12 patients) effective in eliminating superficial colonization. Deep colonization was reduced to 3.1% (2 of 65 patients) compared with previous studies of 15% to 20% (P = .006). BPO/C was 100% effective at decreasing deep colonization with >1 application. P. acnes skin colonization is high at arthroscopic shoulder portals, especially in men. Despite standard skin preparation and prophylactic antibiotics, the rate of joint inoculation is much higher than the rate of infection reported in the literature. BPO/C effectively reduces P. acnes colonization in shoulder arthroscopy. It should be considered for use before shoulder procedures with a time-related trend of >1 application.

Effects of olanexidine gluconate on preoperative skin preparation: an experimental study in cynomolgus monkeys.

PurposeTo determine the bactericidal efficacy of a new topical antiseptic for preoperative skin preparation, olanexidine gluconate (development code: OPB-2045G), against transient or resident bacterial flora on the skin of cynomolgus monkeys.MethodologyAfter measuring baseline bacterial counts on test sites marked on the abdomens, we applied olanexidine, chlorhexidine or povidone–iodine. After 10 min (fast-acting effect) and 6 h (long-lasting effect), bacterial counts were measured again and log10 reductions were calculated. In addition, we determined the bactericidal effects on the skin contaminated with blood before or after applying the antiseptics.ResultsIn the non-blood-contaminated condition, the mean log10 reductions of olanexidine at doses of 1–2 % were significantly higher than those of saline (negative control), but did not significantly differ from those of 0.5 % chlorhexidine and 10 % povidone–iodine at either time point. But olanexidine was significantly more effective at both time points than chlorhexidine and povidone–iodine when applied after the site was contaminated with blood. Olanexidine was also significantly more effective than chlorhexidine and as effective as or more effective than povidone-iodine at both time points when skin was contaminated with blood after the antiseptics were applied.ConclusionThe bactericidal effects of olanexidine were comparable to those of commercial antiseptics such as chlorhexidine and povidone–iodine in non-blood-contaminated conditions. More importantly, the effect of olanexidine was hardly affected by blood unlike commercial antiseptics. Thus, it is considered that olanexidine has a favourable property for skin preparation in various types of surgical treatments.

Comparison of the Efficacy of Chlorhexidine Gluconate versus Povidone Iodine as Preoperative Skin Preparation for the Prevention of Surgical Site Infections

Comparison of the Efficacy of Chlorhexidine Gluconate versus Povidone Iodine as Preoperative Skin Preparation for the Prevention of Surgical Site Infections

Paper #40 - Benzoyl peroxide and clindamycin topical skin preparation decreases Propionibacterium acnes deep colonization in shoulder arthroscopy

Background: Propionibacterium acnes is a gram-positive anaerobic pathogen that can lead to devastating postoperative shoulder infections. Inoculation of the shoulder is thought to occur during skin incision due to colonization of the bacterium in the dermal layer. Dermatology literature demonstrates effective reduction of P. acnes colonization on the skin utilizing a combination benzoyl peroxide 5% and clindamycin phosphate 1% topical gel. The objective of this study was to investigate whether a benzoyl peroxide and clindamycin preoperative surgical skin preparation reduces the incidence of P. acnes inoculation of the shoulder joint during arthroscopy, and to determine the time-related effects of the topical medication on P. acnes colonization. Methods: 49 consecutive shoulder arthroscopy patients from November 2014 to September 2015 were prospectively enrolled. 42 patients completed 21 day cultures and were followed for three months. The first culture was a skin culture was taken at the pre-operative visit from the standard posterior, anterosuperior and anterolateral arthroscopic portal sites. A topical benzoyl peroxide 5% and clindamycin 1% gel was then applied to the shoulder with instructions to apply it every night prior to day of surgery. Routine prophylaxis was used with either Cephalexin 1 gram IV or Vancomycin 1 gram IV or Erythromycin 500 mg IV. The second culture was a skin culture was repeated at the three portal sites in the operating room prior to surgical preparation with 4% chlorhexidine solution, followed by a 2% chlorhexidine gluconate and 70% isopropyl alcohol paint. Shoulder arthroscopy proceeded as indicated with the third culture obtained from within the shoulder at the surgical site via a cannula. Results: Superficial P. acnes colonization of the skin remained similar to prior studies at 57 % (24 of 42 patients.) The topical gel was effective at eliminating 71% (17 of 24 patients) of P. acnes skin colonization by day of surgery. 75 % (3 of 4) of positive intraoperative superficial cultures were found on shoulders that only had 1 preoperative application of benzoyl peroxide and clindamycin. With >1 application (≥2 days prior to surgery), the topical gel was found to be 87.7% (7 of 8 patients) effective in decreasing P. acnes superficial colonization. Surgical site deep colonization was reduced to 4.7% (2 of 42 patients) compared our previous study of 19.6%. Ten control “air swab” cultures were all culture negative at 21 days. Conclusions: Benzoyl peroxide and clindamycin skin preparation is effective in reducing deep shoulder colonization of P. acnes in shoulder arthroscopy. It should be considered for use as a prophylactic topical skin preparation prior to shoulder procedures with a time-related effect of >1 application. Level of Evidence: Level II, prospective cohort study.

A comparison study of preoperative skin preparation using chlorhexidine vs povidone iodine in cases of elective orthopaedic surgery

Preoperative skin preparation is an inalienable part of the patient preparation in any orthopaedic surgery. The obvious goal of this step is to reduce the possibility of a postoperative wound infection. Unfortunately, guidelines/recommendations to achieve these goals are still to be universally agreed upon. The aim of the study was to determine a preferred method for preoperative skin preparation in clean surgeries for closed fractures. We compared the postoperative infection rates in 120 orthopaedic cases managed with elective surgery, which had undergone preoperative skin preparation with either chlorhexidine or povidone iodine. The effect of each method of skin preparation was studied. Results were analyzed statistically The overall rate of surgical site infection was considerably lower in the chlorhexidine group (12.3%) than in the povidone iodine group (6.66%, p=0.008), while the cost of the antiseptics wasn’t different. This study demonstrates that antisepsis with chlorhexidine and was associated with a significant reduction in the rate of SSIs compared to povidone-iodine antisepsis. Hence, Chlorhexidine antiseptics should be the preferred choice for preoperative skin preparation in elective cases of orthopaedic surgery.

Visibility of Tinted Chlorhexidine Gluconate Skin Preparation on Varied Skin Pigmentations.

Preoperative skin preparation with antimicrobial agents decreases the risk of surgical site infection, but concerns have been raised about the visibility of a common surgical preparatory agent (ChloraPrep; Becton, Dickinson & Co, Franklin Lakes, New Jersey), depending on skin pigmentation. Poor visibility may lead to failure to identify inadequately prepared skin, increasing the risk of surgical site infection. This study was conducted to determine whether different tints of ChloraPrep and different skin pigmentations affect the ability of orthopedic surgeons to identify the adequacy of skin preparation. The forearms of volunteers in 4 skin pigmentation categories (fair, medium-fair, medium-dark, and dark) were prepared with Hi-Lite Orange and Scrub Teal ChloraPrep, with 1 forearm prepared adequately and 1 prepared inadequately. Videos showing the forearms were obtained and compiled into a survey that was sent to orthopedic surgeons, who were asked to assess the adequacy of skin preparation. When the 4 pigmentation categories were aggregated, no difference was noted between Hi-Lite Orange and Scrub Teal tints in rates of correct identification of adequate skin preparation by respondents. When the preparation tint was not controlled for, respondents correctly identified the adequacy of skin preparation for fair and medium-fair pigmentations, but not for medium-dark and dark skin pigmentations. The Hi-Lite Orange tint was significantly easier to identify on fair and medium-fair skin pigmentations, and the Scrub Teal tint was easier to identify on medium-dark and dark skin pigmentations. To reduce the risk of surgical site infection, surgeons should use Hi-Lite Orange on patients whose skin is fair or medium-fair and Scrub Teal on patients whose skin is medium-dark or dark. [Orthopedics. 2017; 40(1):e44-e48.].

Meticulous nursing of indwelling urinary catheter between the children with hypospadias during perioperative

Objective To summarize the meticulous nursing experience of indwelling urinary catheter between the children with hypospadias during perioperative. Methods 317 cases of indwelling urethral only in the silicone Foley tube, and without other urinary diversion with hypospadias were retrospectively analyzed, summarized the fine points of nursing, including preoperative children with comprehensive risk assessment, standardized preoperative skin preparation and postoperative protective constraint, effective properly fixed catheter keep the urine drainage unobstructed, close observation of urine drainage characteristics, maintain urine collection system tightness, maintain perineal skin clean and improved extubation nursing method, and do a good job after extubation nursing. Results 266 cases were cured with a cure rate of 83.9%(266/317); the incidence of urine leakage in 42 cases, the incidence rate was 13.2% (42/317); 7 cases of urethral stenosis, the incidence rate was 2.2% (7/317); 2 cases of urethral closing, the incidence was 0.6% (2/317), none of the patients had accidental extubation. Conclusions The meticulous nursing has a better effect in hypospadias patients during the perioperative period and it can reduce the incidence of postoperative complications; shorten the time of hospitalization and alleviate the suffering of children; improve the quality of nursing service, which is worthy of clinical application. Key words: Hypospadias; Perioperative nursing; Indwelling urinary catheter; Meticulous nursing

Simple foot holder saves your theatre practitioner's back: a technical tip.

We provide a simple technique for foot positioning during preoperative skin preparation. Prone headrest made of gel polymer is used to support the patient's leg to keep the foot up. This will protect your operating theatre practitioner's back avoiding any mechanical back strain. It will also save money by preventing sickness and reducing workplace litigation from back injuries.

Hang Them High: A Hands-Free Technique for Upper Extremity Limb Holding During Surgical Preparation.

Lifting and holding upper and lower limbs during the "prep and drape" portion of certain orthopaedic procedures exert strong forces on the holder and may lead to musculoskeletal disorders. To address these challenges during upper extremity procedures, this article describes a hand-free elevation and traction technique of the upper limbs during preoperative skin preparation with the use of items readily available within the operating room (OR). This technique is particularly useful for heavy or fractured limbs that may impose a physical challenge to lift and maintain in a stable position. Implementation of this technique reduces the risk to nurses, OR personnel, and caregivers of developing work-related musculoskeletal injuries while lifting and holding limbs in the orthopaedic OR.