Comparison of surgical wound infection after preoperative skin preparation with 4% chlorhexidine [correction of chlohexidine] and povidone iodine: a prospective randomized trial.
79
Citation
0
Reference
20
Related Paper
Citation Trend
Abstract:
Antiseptic scrub and paint can reduce bacterial colonization and postoperative wound infection. Two forms of antiseptics, povidone iodine and chlorhexidine, are commonly used in the operating theater.To study the efficacy of the reduction of bacterial colonization and surgical wound infection among these antiseptic.Five hundred surgical patients were randomly divided into two groups. Povidone Iodine and Chlorhexidine were used for skin preparation in group 1 and 2 respectively Bacterial colonization and postoperative wound infection were examined after skin preparation. Demographic data was analyzed by student's t test; the culture result and surgical wound infection were analyzed by Mantel-Haenszel method for relative risk and 95% CI.There was a significant reduction of bacterial colonization and wound infection after skin preparation in group 2 compared with group 1.Colonization of bacterial and postoperative surgical wound infection were significantly reduced in the chlorhexidine group. Chlorhexidine antiseptic should be the first consideration for preoperative skin preparation.Keywords:
Antiseptic
Microbiological culture
Surgical wound
Wound infection
Cite
Abstract Background Surgical-site infection increases morbidity, mortality and financial burden. The preferred topical antiseptic agent (chlorhexidine or povidone–iodine) for preoperative skin cleansing is unclear. Methods A meta-analysis of clinical trials was conducted to determine whether preoperative antisepsis with chlorhexidine or povidone–iodine reduced surgical-site infection in clean-contaminated surgery. Results The systematic review identified six eligible studies, containing 5031 patients. Chlorhexidine reduced postoperative surgical-site infection compared with povidone–iodine (pooled odds ratio 0·68, 95 per cent confidence interval 0·50 to 0·94; P = 0·019). Conclusion Chlorhexidine should be used preferentially for preoperative antisepsis in clean-contaminated surgery.
Cite
Citations (185)
To compare the effects of different skin preparation solutions on surgical-site infection rates.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.Single large academic medical center.All adult general surgery patients.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).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.
Isopropyl alcohol
Iodophor
Surgical Site Infection
Cite
Citations (229)
In a prospective, randomized study, 737 patients who were evaluated had the operative site prepared preoperatively by either a 0.5 per cent chlorhexidine gluconate spray or povidone-iodine scrub. The wound infection rate in these two comparable groups was not statistically different, although slightly favoring the spray technique (6.0 versus 8.1 per cent). The spray technique challenges the conventional preoperative scrub and offers further advantages of increased effectiveness while also offering savings of time and expense.
Iodophor
Chlorhexidine gluconate
Cite
Citations (58)
Antiseptic
Cite
Citations (132)
Objective. To compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost. Methods. We searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application. One reviewer extracted data and assessed individual study quality, quality of evidence for each outcome, and publication bias. Meta-analyses were performed using a fixed-effects model. Using results from the meta-analysis and cost data from the Hospital of the University of Pennsylvania, we developed a decision analytic cost-benefit model to compare the economic value, from the hospital perspective, of antisepsis with iodine versus antisepsis with 2 preparations of chlorhexidine (ie, 4% chlorhexidine bottle and single-use applicators of a 2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol [IPA] solution), and also performed sensitivity analyses. Results. Nine RCTs with a total of 3,614 patients were included in the meta-analysis. Meta-analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51–0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35–0.56]) than was iodine antisepsis. In the cost-benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of $16-$26 per surgical case and $349,904–$568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances. Conclusions. Preoperative skin antisepsis with chlorhexidine is more effective than preoperative skin antisepsis with iodine for preventing SSI and results in cost savings.
Antiseptic
Cite
Citations (231)
Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine.We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections.A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups.Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)
Antiseptic
Surgical Site Infection
Chlorhexidine gluconate
Cite
Citations (1,366)
No AccessJournal of UrologyAdult Urology1 Jan 2013A Comparison of Chlorhexidine-Alcohol Versus Povidone-Iodine for Eliminating Skin Flora Before Genitourinary Prosthetic Surgery: A Randomized Controlled Trial Lawrence L. Yeung, Shaun Grewal, Arnold Bullock, H. Henry Lai, and Steven B. Brandes Lawrence L. YeungLawrence L. Yeung Department of Urology, University of Florida, Gainesville, Florida , Shaun GrewalShaun Grewal Division of Urology, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri , Arnold BullockArnold Bullock Division of Urology, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri , H. Henry LaiH. Henry Lai Division of Urology, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri , and Steven B. BrandesSteven B. Brandes Division of Urology, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri View All Author Informationhttps://doi.org/10.1016/j.juro.2012.08.086AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We defined the relevant skin flora during genitourinary prosthetic surgery, evaluated the safety of chlorhexidine-alcohol for use on the male genitalia and compared chlorhexidine-alcohol to povidone-iodine in decreasing the rate of positive bacterial skin cultures at the surgical skin site before prosthetic device implantation. Materials and Methods: In this single institution, prospective, randomized, controlled study we evaluated 100 consecutive patients undergoing initial genitourinary prosthetic implantation. Patients were randomized to a standard skin preparation with povidone-iodine or chlorhexidine-alcohol. Skin cultures were obtained from the surgical site before and after skin preparation. Results: A total of 100 patients were randomized, with 50 in each arm. Pre-preparation cultures were positive in 79% of the patients. Post-preparation cultures were positive in 8% in the chlorhexidine-alcohol group compared to 32% in the povidone-iodine group (p = 0.0091). Coagulase-negative staphylococci were the most commonly isolated organisms in post-preparation cultures in the povidone-iodine group (13 of 16 patients) as opposed to propionibacterium in the chlorhexidine-alcohol group (3 of 4 patients). Clinical complications requiring additional operations or device removal occurred in 6 patients (6%) with no significant difference between the 2 groups. No urethral or genital skin complications occurred in either group. Conclusions: Chlorhexidine-alcohol was superior to povidone-iodine in eradicating skin flora at the surgical skin site before genitourinary prosthetic implantation. There does not appear to be any increased risk of urethral or genital skin irritation with the use of chlorhexidine compared to povidone-iodine. Chlorhexidine-alcohol appears to be the optimal agent for skin preparation before genitourinary prosthetic procedures. References 1 : Candida infections of medical devices. Clin Microbiol Rev2004; 17: 255. Google Scholar 2 : Urinary and sexual function after radical prostatectomy for clincally localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA2000; 283: 354. Google Scholar 3 : Biofilm and penile prosthesis infections in the era of coated implants: a review. J Sex Med2012; 9: 44. Google Scholar 4 : Risk factors for penile prosthetic infection. J Urol1996; 156: 402. Link, Google Scholar 5 : Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin. J Urol1998; 159: 1537. Link, Google Scholar 6 : Prevention of infection in revision of penile prosthesis using antibiotic coated prosthesis and Mulcahy salvage protocol. J Urol2003; 169: 325. abstract 1264. Google Scholar 7 : 13 Years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol2007; 177: 1021. Link, Google Scholar 8 : Intermediate-term results, up to 4 years, of a bone-anchored male perineal sling for treating male stress urinary incontinence after prostate surgery. BJU Int2009; 103: 500. Google Scholar 9 : Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am2009; 91: 1949. Google Scholar 10 : Chlorhexidine-alcohol versus povidone-iodine for surgical site antisepsis. N Engl J Med2010; 362: 18. Google Scholar 11 : What drives bacteria to produce a biofilm?. FEMS Microbiol Lett2004; 236: 163. Google Scholar 12 : New aspects in the molecular basis of polymer-associated infections due to Staphylococcus. Eur J Clin Microbiol Infect Dis1999; 18: 843. Google Scholar 13 : The application of biofilm science to the study and control of chronic bacterial infections. J Clin Invest2003; 112: 1466. Google Scholar 14 Data on file. CareFusion, Inc., San Diego, California. Google Scholar 15 : Skin preparation for the prevention of surgical siteinfection: which agent is best?. Rev Urol2009; 11: 190. Google Scholar 16 : Surgical infection. In: Equine Surgery. Edited by . Philadelphia: WB Saunders1992: 47. Google Scholar 17 : Centers of excellence concept and penile prostheses: an outcome analysis. J Urol2009; 181: 1264. Link, Google Scholar 18 : Comparison of preoperative skin preparation products. Pharmacotherapy2001; 21: 345. Google Scholar 19 : Infection control: start with skin. Nurs Manage2006; 37: 46. Google Scholar 20 : Revision washout decreases penile prosthesis infection in revision surgery: a multicenter study. J Urol2005; 173: 89. Link, Google Scholar 21 : Propionibacterium acnes: infection beyond the skin. Expert Rev Anti Infect Ther2011; 9: 1149. Google Scholar 22 : High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,998 patients from national surgical quality improvement database. Ann Surg2012; 255: 551. Google Scholar 23 : What does one minute of operating room time cost?. J Clin Anesth2010; 22: 233. Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLinder B, Piotrowski J, Ziegelmann M, Rivera M, Rangel L and Elliott D (2015) Perioperative Complications following Artificial Urinary Sphincter PlacementJournal of Urology, VOL. 194, NO. 3, (716-720), Online publication date: 1-Sep-2015.Seftel A (2014) Re: A Population-Based Analysis of Contemporary Rates of Reoperation for Penile Prosthesis ProceduresJournal of Urology, VOL. 192, NO. 6, (1774-1776), Online publication date: 1-Dec-2014.Katz B, Gaunay G, Barazani Y, Nelson C, Moreira D, Dinlenc C, Nagler H and Stember D (2014) Use of a Preoperative Checklist Reduces Risk of Penile Prosthesis InfectionJournal of Urology, VOL. 192, NO. 1, (130-135), Online publication date: 1-Jul-2014. Volume 189Issue 1January 2013Page: 136-140 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordspenile implantationurinary sphincter, artificialsuburethral slingspovidone-iodinechlorhexidineAcknowledgmentsLiu Yang assisted with statistical analysis.MetricsAuthor Information Lawrence L. Yeung Department of Urology, University of Florida, Gainesville, Florida Nothing to disclose. More articles by this author Shaun Grewal Division of Urology, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri Nothing to disclose. More articles by this author Arnold Bullock Division of Urology, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri Financial interest and/or other relationship with Pfizer, Astellas, American Medical Systems Inc. and Coloplast. More articles by this author H. Henry Lai Division of Urology, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri Financial interest and/or other relationship with Pfizer and Astellas. More articles by this author Steven B. Brandes Division of Urology, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri Financial interest and/or other relationship with Astellas, American Medical Systems Inc. and Allergan. More articles by this author Expand All Advertisement PDF downloadLoading ...
Skin flora
Flora
Cite
Citations (96)
Bathing
Surgical Site Infection
Cite
Citations (513)
The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines. Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.
Guideline
Surgical Site Infection
Disease Control
Surgical wound
Disease Prevention
Cite
Citations (4,405)
Background Surgical site infection rates in the month following clean surgery vary from 0.6% (knee prosthesis) to 5% (limb amputation). Due to the large number of clean surgical procedures conducted annually the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Preoperative skin antisepsis using antiseptics is performed to reduce the risk of SSIs by removing soil and transient organisms from the skin where a surgical incision will be made. Antiseptics are thought to be toxic to bacteria and therefore aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however, it is unclear whether preoperative skin antisepsis actually reduces postoperative wound infection, and, if so, which antiseptic is most effective. Objectives To determine whether preoperative skin antisepsis immediately prior to surgical incision for clean surgery prevents SSI and to determine the comparative effectiveness of alternative antiseptics. Search methods For this second update we searched the The Cochrane Wounds Group Specialised Register (searched 7 August 2012), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7), Ovid MEDLINE (1950 to July Week 4 2012), Ovid MEDLINE (In‐Process & Other Non‐Indexed Citations August 06, 2012), Ovid EMBASE (1980 to 2012 Week 31), EBSCO CINAHL (2007 to 3 August 2012). Selection criteria Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There was no restriction on the inclusion of reports based on language of publication, date or publication status. Data collection and analysis Data extraction and assessment of risk of bias were undertaken independently by two review authors. Main results Thirteen studies were included in this review (2,623 participants). These evaluated several different types of skin antiseptics ‐ leading to 11 different comparisons being made. Although the antiseptics evaluated differed between studies, all trials involved some form of iodine. Iodine in alcohol was compared to alcohol alone in one trial; one trial compared povidone iodine paint (solution type not reported) with soap and alcohol. Six studies compared different types of iodine‐containing products with each other and five compared iodine‐containing products with chlorhexidine‐containing products. There was evidence from one study suggesting that preoperative skin preparation with 0.5% chlorhexidine in methylated spirits led to a reduced risk of SSI compared with an alcohol based povidone iodine solution: RR 0.47 (95% CI 0.27 to 0.82). However, it is important to note that the trial does not report important details regarding the interventions (such as the concentration of povidone iodine paint used) and trial conduct, such that risk of bias was unclear. There were no other statistically significant differences in SSI rates in the other comparisons of skin antisepsis. Overall the risk of bias in included studies was unclear. A mixed treatment comparison meta‐analysis was conducted and this suggested that alcohol‐containing products had the highest probability of being effective ‐ however, again the quality of this evidence was low. Authors' conclusions A comprehensive review of current evidence found some evidence that preoperative skin preparation with 0.5% chlorhexidine in methylated spirits was associated with lower rates of SSIs following clean surgery than alcohol‐based povidone iodine paint. However this single study was poorly reported. Practitioners may therefore elect to consider other characteristics such as costs and potential side effects when choosing between alternatives. The design of future trials should be driven by the questions of high priority to decision makers. It may be that investment in at least one large trial (in terms of participants) is warranted in order to add definitive and hopefully conclusive data to the current evidence base. Ideally any future trial would evaluate the iodine‐containing and chlorhexidine‐containing solutions relevant to current practice as well as the type of solution used (alcohol vs. aqueous).
Antiseptic
Surgical wound
CINAHL
Cite
Citations (375)