Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates A Prospective Study of 3 Skin Preparation Protocols
- 1 October 2009
- journal article
- Published by Cambridge University Press (CUP) in Infection Control & Hospital Epidemiology
- Vol. 30 (10), 964-971
- https://doi.org/10.1086/605926
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.Keywords
This publication has 23 references indexed in Scilit:
- Efficacy of Protocol Implementation on Incidence of Wound Infection in Colorectal OperationsJournal of the American College of Surgeons, 2007
- Resistance of antimicrobial skin preparations to saline rinse using a seeded bacteria modelAmerican Journal of Infection Control, 2007
- Single-Institutional Experience with the Surgical Infection Prevention Project in Intra-Abdominal SurgerySurgical Infections, 2007
- Analyses Comparing the Antimicrobial Activity and Safety of Current Antiseptic AgentsJournal of Infusion Nursing, 2005
- Surgical Site Infection (SSI) Rates in the United States, 1992–1998: The National Nosocomial Infections Surveillance System Basic SSI Risk IndexClinical Infectious Diseases, 2001
- Morbidity and mortality associated withsurgical site infections: results from the 1997–1999 INCISO surveillanceJournal of Hospital Infection, 2001
- Supplemental Perioperative Oxygen to Reduce the Incidence of Surgical-Wound InfectionNew England Journal of Medicine, 2000
- Guideline for Prevention of Surgical Site Infection, 1999American Journal of Infection Control, 1999
- Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten HospitalizationNew England Journal of Medicine, 1996
- Comparison of a One-Step Iodophor Skin Preparation Versus Traditional Preparation in Total Joint SurgeryPublished by Ovid Technologies (Wolters Kluwer Health) ,1990