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Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates A Prospective Study of 3 Skin Preparation Protocols

Published online by Cambridge University Press:  02 January 2015

Brian R. Swenson ,
Traci L. Hedrick ,
Rosemarie Metzger ,
Hugo Bonatti ,
Timothy L. Pruett  and
Robert G. Sawyer
Brian R. Swenson*
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Traci L. Hedrick
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Rosemarie Metzger
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Hugo Bonatti
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Timothy L. Pruett
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Robert G. Sawyer
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville Public Health Sciences, University of Virginia Health System, Charlottesville
*
Department of Surgery, University of Virginia Health System, PO Box 800300, Charlottesville, VA 22908-0300 ([email protected])
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Abstract

Objective.

To compare the effects of different skin preparation solutions on surgical-site infection rates.

Design.

Three skin preparations were compared by means of a sequential implementation Design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% Chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner.

Setting.

Single large academic medical center.

Patients.

All adult general surgery patients.

Results.

The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% Chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001).

Conclusions.

Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to Chlorhexidine for this purpose in general surgery patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 10 , October 2009 , pp. 964 - 971
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Astagneau, P, Rioux, C, Golliot, F, Brucker, G. Morbidity and mortality associated with surgical-site infections: results from the 1997-1999 INCISO surveillance. J Hosp Infect 2001;48:267–274.Google Scholar
2.Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.Google Scholar
3.Kurz, A, Sessler, DI, Lenhardt, R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996;334:1209–1215.Google Scholar
4.Greif, R, Akca, O, Horn, EP, Kurz, A, Sessler, DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Engl J Med 2000;342:161–167.Google Scholar
5.Gaynes, RP, Culver, DH, Horan, TC, Edwards, JR, Richards, C, Toison, JS. Surgical-site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001;33(Suppl 2):S69–77.Google Scholar
6.Swenson, BR, Hollenbeak, CS, Koltun, WA. Hospital costs and risk factors associated with complications of the ileal pouch anal anastomosis. Surgery 2002;132:767–773.Google Scholar
7.Hibbard, JS, Mulberry, GK, Brady, AR. A clinical study comparing the skin antisepsis and safety of ChloraPrep, 70% isopropyl alcohol, and 2% aqueous Chlorhexidine. J Infus Nurs 2002;25:244–249.Google Scholar
8.Hibbard, JS. Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review. J Infus Nurs 2005;28:194–207.Google Scholar
9.Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomised trial of povidone-iodine, alcohol, and Chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339–343.Google Scholar
10.Birnbach, DJ, Meadows, W, Stein, DJ, Murray, O, Thys, DM, Sordillo, EM. Comparison of povidone-iodine and DuraPrep, an iodophor-in-isopropyl alcohol solution, for skin disinfection prior to epidural catheter insertion in parturients. Anesthesiology 2003;98:164–169.Google Scholar
11.Gilliam, DL, Nelson, CL. Comparison of a one-step iodophor skin preparation versus traditional preparation in total joint surgery. Clin Orthop Relat Res 1990;250:258–260.Google Scholar
12.Jeng, DK, Severin, JE. Povidone-iodine gel alcohol: a 30-second, onetime application preoperative skin preparation. Am J Infect Control 1998;26:488–494.Google Scholar
13.Stahl, JB, Morse, D, Parks, PJ. Resistance of antimicrobial skin preparations to saline rinse using a seeded bacteria model. Am J Infect Controllail 35:367–373.CrossRefGoogle Scholar
14.MedQIP-SCIP. Available at: https://www.qualitynet.org. Accessed September 3, 2009.Google Scholar
15.Hedrick, TL, Turrentine, FE, Smith, RL, et al.Single-institutional experience with the surgical infection prevention project in intra-abdominal surgery. Surg Infect (Larchmt) 2007;8:425–435.CrossRefGoogle ScholarPubMed
16.Hedrick, TL, Heckman, JA, Smith, RL, Sawyer, RG, Friel, CM, Foley, EF. Efficacy of protocol implementation on incidence of wound infection in colorectal operations. J Am Coll Surg 2007;205:432–438.Google Scholar
17.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical-site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.Google Scholar
18.Brooks, RA, Hollinghurst, D, Ribbans, WJ, Severn, M. Bacterial recolonization during foot surgery: a prospective randomized study of toe preparation techniques. Foot Ankle Int 2001;22:347–350.CrossRefGoogle ScholarPubMed
19.Ostrander, RV, Botte, MJ, Brage, ME. Efficacy of surgical preparation solutions in foot and ankle surgery. J Bone Joint Surg Am 2005;87:980–985.Google Scholar
20.Chaiyakunapruk, N, Veenstra, DL, Lipsky, BA, Saint, S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a metaanalysis. Ann Intern Med 2002;136:792–801.Google Scholar
21.Mimoz, O, Villeminey, S, Ragot, S, et al.Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med 2007;167:2066–2072.CrossRefGoogle ScholarPubMed