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Mehraban N, Wakefield C, Rossi D, Lin J, Lee S, Hamid KS, Bohl DD. Randomized Trial of Dilute Povidone-Iodine Soak and Scrub for Orthopaedic Foot and Ankle Surgery. Foot Ankle Int 2021; 42:1589-1597. [PMID: 34282647 DOI: 10.1177/10711007211025263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus as to which skin antiseptic solution is most effective at reducing infection following orthopaedic foot and ankle surgery. The purpose of this study is to determine if the addition of a dilute povidone-iodine soak and scrub to a standard preparation with alcohol and chlorhexidine decreases positive bacterial culture rates from the hallux nailfold. METHODS In this prospective, randomized controlled trial, 242 subjects undergoing orthopaedic foot and ankle surgery were randomized to one of 2 groups. The control group received our standard 2-step skin antiseptic preparation of an alcohol scrub (step 1) followed by chlorhexidine/alcohol paint (step 2). The intervention group received a 3-minute dilute povidone-iodine soak and scrub followed by that same standard 2-step skin preparation. Immediately before skin incision, culture swabs were taken from the hallux nailfold of both groups. RESULTS Of the 257 subjects enrolled and randomized, 242 (94.2%) completed the study, satisfying the a priori sample size requirement of 242 subjects. There were no crossovers between groups. There were no differences in baseline characteristics between groups (P > .05 for each). There was no difference in bacterial growth rates between groups (26.8% growth in the intervention group vs 26.9% growth in the control group, P = .991). CONCLUSION The hallux nailfold is one of the most difficult to sterilize areas prior to orthopaedic foot and ankle surgery. This randomized controlled trail found no benefit to adding a 3-minute dilute povidone-iodine soak and scrub to a standard skin preparation with alcohol and chlorohexidine. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Nasima Mehraban
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Connor Wakefield
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - David Rossi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Johnny Lin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Dockery DM, Allu S, Vishwanath N, Li T, Berns E, Glasser J, Spake CSL, Antoci V, Born CT, Garcia DR. Review of Pre-Operative Skin Preparation Options Based on Surgical Site in Orthopedic Surgery. Surg Infect (Larchmt) 2021; 22:1004-1013. [PMID: 34388024 DOI: 10.1089/sur.2021.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgical site infections (SSIs) are a primary contributor to surgical morbidity and mortality, causing a substantial financial burden on the healthcare system. Specifically, Cutibacterium acnes contributes greatly to infections in the shoulder and spine regions. Prevention of infection is crucial to improve patient outcomes and reduce costs. This article reviews current surgical skin preparation solutions, the unique distribution of organisms at common orthopedic surgical sites, and recommends solutions based on surgical location. Methods: A search of electronic databases (PubMed, MEDLINE, and Embase) was conducted for relevant literature until December 2020. Sources were compiled based on title and abstract, then full texts were read for possible inclusion. This review summarizes the most recent publications in the field of SSIs and preparation solutions. Results: The mechanism and efficacy of alcohol-, iodine-, and chlorhexidine-based preparations were reviewed, along with experimental preparations. This article identifies common colonization patterns for the shoulder, elbow, hip, knee, spine, foot, and ankle, and discusses recommendations for preparations based on current evidence. Recommendations: For shoulder and elbow operations, we recommend ChloraPrep™ (CareFusion, BD, El Paso, TX), DuraPrep™ (3M Health Care, St. Paul, MN), or Betadine® applied with 4 × 4 gauze sponge, three-day pre-operative benzyl peroxide, and application of 3% hydrogen peroxide before skin preparation. For the hip and knee, we recommend application of 2% chlorhexidine gluconate (CHG) cloth the night before and morning of surgery and either DuraPrep or iodine-alcohol skin prep prior to surgery. For spine surgeries, we recommended ChloraPrep. For foot and ankle, our recommendations are: ChloraPrep or DuraPrep, submersion of foot in 70% ethanol/10% isopropyl alcohol for five minutes prior to procedure, application with a bristled brush, and a second vigorous scrub with 4 × 4 soaked gauze. Conclusions: The current surgical skin preparations have both benefits and drawbacks. We recommend that orthopedic surgeons choose a skin preparation based on surgical site and prevalence of unique skin flora there.
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Affiliation(s)
- Dominique M Dockery
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Sai Allu
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA
| | - Neel Vishwanath
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Troy Li
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA
| | - Ellis Berns
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jillian Glasser
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Carole S L Spake
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Valentin Antoci
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher T Born
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Dioscaris R Garcia
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Brown University, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Mehraban N, Holmes GB, Lin J, Lee S, Hamid KS, Bohl DD. Skin Preparation Techniques for Orthopedic Foot and Ankle Surgery: A Current Concepts Review. Foot Ankle Int 2020; 41:1007-1016. [PMID: 32517493 DOI: 10.1177/1071100720925480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Surgical site infection (SSI) following orthopedic foot and ankle surgery is associated with morbidity, mortality, and cost to the healthcare system. The local anatomy and physiology predispose patients undergoing procedures to elevated risk. In particular, sterilizing of the webspaces, nailfolds, and subungual areas presents challenges, and the preferred skin antisepsis technique for foot and ankle procedures has not yet been defined. Skin antiseptic solutions (SASs) consist of 3 main categories: alcohol, chlorhexidine, and iodine-based solutions. This review of the literature supports a combined chlorhexidine and alcohol preparation technique; however, there are a number of studies that suggest otherwise. In addition, there is variable evidence for the use of alternatives to the standard soft sponge application technique, including immersion, bristled brush, and cotton gauze application. These alternatives may have a particular advantage in the forefoot. Most studies to date use growth from skin swab cultures after skin preparation as the primary outcome. Higher-level studies with large subject populations and more meaningful clinical outcomes will be required to solidify guidelines for preoperative skin antisepsis prior to foot and ankle procedures.Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Nasima Mehraban
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - George B Holmes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Johnny Lin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Abstract
Surgical site infections (SSIs) in orthopaedics are a common complication, with more than half a million SSIs occurring in the United States each year. SSIs can carry a notable burden for patients and physicians alike. Skin antiseptic solution plays an important role in preventing SSI. Many studies have looked at different skin antiseptic solution in preventing SSIs. Different surgical preps can decrease bacterial loads at surgical sites in varying degrees. Yet, the amount of bacterial load does not always correlate with a lower risk of infection.Chlorhexidine, for example, has been shown to cause markedly less SSIs compared with povidone-iodine prep in general surgery cases. Whereas chlorhexidine with alcohol may best work in the forefoot, iodine povacrylex with alcohol is equivalent in the spine. Conversely, joint arthroplasty SSIs were markedly decreased with a combination of preps. Because of all these differences, understanding which prep solution to use and when can be invaluable to the orthopaedic surgeons.
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Shadid MB, Speth MJGM, Voorn GP, Wolterbeek N. Chlorhexidine 0.5%/70% Alcohol and Iodine 1%/70% Alcohol Both Reduce Bacterial Load in Clean Foot Surgery: A Randomized, Controlled Trial. J Foot Ankle Surg 2019; 58:278-281. [PMID: 30612875 DOI: 10.1053/j.jfas.2018.08.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Indexed: 02/03/2023]
Abstract
No consensus exists regarding which cleansing technique, solution, and concentration should be used in orthopedic surgery. The aim of this randomized, controlled trial was to compare the effect of chlorhexidine 0.5%/70% alcohol with iodine 1%/70% alcohol on lowering positive cultures before elective foot surgery and to study any wound complications, infections and allergic reactions. Consecutive patients ≥18 years of age scheduled for a hallux valgus correction or arthrodesis of the first metatarsophalangeal joint were included. Swabs were taken from 2 sites before and twice after preparing the skin and were quantitatively and qualitatively analyzed. The study group consisted of 49 patients with a mean age of 52.3 ± 14.4 (range 22 to 75) years of whom 42 (86%) were female. No significant differences were observed for positive cultures between the chlorhexidine (73%, 2%, and 12%) and iodine (68%, 7%, and 9%) group at any time point. Coagulase-negative staphylococci were the most commonly isolated micro-organisms found after skin preparation. Occasionally, Bacillus spp and Corynebacterium spp were cultured. The complication rate 2 weeks postoperatively was 0% in the chlorhexidine group versus 8.7% (n = 2) in the iodine group (delayed wound healing; p = .215). The complication rate at 6 weeks postoperatively was, respectively, 3.8% (n = 1) versus 4.3% (n = 1; both showed swelling and redness; p > .999). There was no significant difference in postoperative wound problems or infection rates between the 2 skin preparation solutions. Chlorhexidine 0.5%/70% alcohol and iodine 1%/70% alcohol both decreased the amount of positive cultures in elective foot surgery.
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Affiliation(s)
- Marwan B Shadid
- Orthopedic Surgeon, Department of Orthopedic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Mario J G M Speth
- Orthopedic Surgeon, Department of Orthopedic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - G Paul Voorn
- Medical Doctor and Microbiologist, Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Nienke Wolterbeek
- Research Coordinator, Department of Orthopedic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
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7
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Abstract
The literature for prevention of surgical infection related primarily to foot and ankle surgery is sparse, with most attention on total joint replacement and abdominal surgery. Attention should be paid to preoperative, intraoperative, and postoperative elements, which can have an effect on the development of postoperative infection. Although antibiotic prophylaxis typically is discussed in isolation, inclusion of this step into the process enhances the overall evaluation of surgery with respect to infection. This evolution provides for better patient outcomes and decreases the likelihood of an infection incurred after foot and ankle surgery.
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Affiliation(s)
- John Boyd
- Section of Podiatry, Department of Surgery, St. Vincent Charity Medical Center, 2322 East 22nd Street, Cleveland, OH 44115, USA.
| | - Richard Chmielewski
- Section of Podiatry, Department of Surgery, St. Vincent Charity Medical Center, 2322 East 22nd Street, Cleveland, OH 44115, USA
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8
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Dick AG, Dhinsa B, Walker RP, Singh S. Delayed Allergic Reaction to ChloraPrep TM in Foot and Ankle Surgery. J Foot Ankle Surg 2019; 58:192-194. [PMID: 30448375 DOI: 10.1053/j.jfas.2018.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Indexed: 02/03/2023]
Abstract
Chlorhexidine-based skin preparations are frequently used in orthopaedic surgery. We report 2 recent cases of patients suffering significant allergic reactions to ChloraPrepTM complicating routine foot and ankle surgery. We advise vigilance for this possible issue and recommend thorough removal of all preparation at the end of the procedure.
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Affiliation(s)
- Alastair G Dick
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Baljinder Dhinsa
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Roland P Walker
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Samrendu Singh
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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9
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Preoperative disinfection of foot and ankle: microbiological evaluation of two disinfection methods. Arch Orthop Trauma Surg 2018; 138:1389-1394. [PMID: 29992377 PMCID: PMC6132941 DOI: 10.1007/s00402-018-2996-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of the current study was to investigate the effect of a footbath in alcohol prior to preoperative disinfection on bacterial flora of the foot and ankle. METHODS Twenty-two volunteers underwent skin preparation mimicking pre-surgical disinfection. One foot was submerged in a bag filled with 70% ethanol containing 10% IPA for 5 min after which it was painted with regular 0.5% chlorhexidine in 70% alcohol. The other foot was only painted with 0.5% chlorhexidine in 70% alcohol. Swabs were taken at four locations: (1) under the nailfold of the first toe, (2) first webspace, (3) sinus tarsi and (4) pre-tibial. A quantitative and qualitative analysis of the cultures was performed. RESULTS No statistically significant difference between the number of positive cultures between the two methods was observed. The number of colony forming units was statistically significantly lower on two locations in the footbath group (i.e., subungual and the first webspace) (median 1 versus median 92 p =0.03 and median 0 versus median 1 p =0.03, respectively). The number of cultures with heavy growth was lower in the footbath group under the nailfold of the first toe (5 versus 13 p =0.008). Thirty-eight different microorganisms were cultured. CONCLUSION A footbath in alcohol prior to regular preoperative skin antisepsis significantly reduces the amount of bacteria under the nailfold and in the first webspace. The number of cultures with heavy growth is lower after a footbath in alcohol. LEVEL OF EVIDENCE IV.
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10
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Fernández-Prada M, Martínez-Ortega C, Revuelta-Mariño L, Menéndez-Herrero Á, Navarro-Gracia JF. Evaluation of the Bundle “Zero Surgical Site Infection” to Prevent Surgical Site Infection in Vascular Surgery. Ann Vasc Surg 2017; 41:160-168. [DOI: 10.1016/j.avsg.2016.09.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 11/16/2022]
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Kim SH, Tan KL, Lee SY, Kim DW, Shin S, Jin HR. Effect of chlorhexidine pretreatment on bacterial contamination at rhinoplasty field. SPRINGERPLUS 2016; 5:2116. [PMID: 28090430 PMCID: PMC5201600 DOI: 10.1186/s40064-016-3679-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study investigated on bacterial contamination of the rhinoplasty field. The effect of preoperative chlorhexidine treatment on decreasing bacterial contamination in the rhinoplasty field is examined. METHODS Thirty patients who underwent rhinoplasty were block randomized into a chlorhexidine, regular-soap, or control group comprising ten participants each. The chlorhexidine group was subjected to chlorhexidine showering, shampooing, and facial-cleansing 12 h prior to the operation. The regular-soap group was subjected to cleansing with regular soap, and the control group did not have any skin pretreatment. Bacterial cultures were done 12 h preoperatively from nasal cavity and perinasal skin, immediately preoperatively from perinasal skin and at 1 and 2 h intraoperatively from operation field. Culture results were compared between the three groups, according to operation time, or whether infection-prone procedure was performed. RESULTS The bacterial species and colony-forming unit numbers at preoperative nasal cavity and perinasal skin were similar. In all three groups, Coagulase-negative staphylococcus was the most common bacteria found in the rhinoplasty field. The numbers of Staphylococcus aureus and Corynebacterium decreased rapidly after preoperative chlorhexidine treatment. The infection-prone procedure was associated with increased bacterial numbers over time during the operation. In all three groups, there was no postoperative infection in a follow-up period of 6 months. CONCLUSION Rhinoplasty is confirmed as a clean contaminated operation with skin flora consistently found in the operation field. Chlorhexidine pretreatment in rhinoplasty patients has a tendency to decrease the numbers of Staphylococcus aureus and Corynebacterium on the perinasal skin. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- Shin Hye Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Keng Lu Tan
- Department of Otorhinolaryngology-Head and Neck Surgery, University Malaya, Kuala Lumpur, Malaysia
| | - Sang Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Korea
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Korea
| | - Sue Shin
- Department of Laboratory Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Ryul Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Korea
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Chang A, Hughes A, du Moulin W, Mukerjee C, Molnar R. Randomised comparison of two skin preparation methods in foot and ankle surgery. Foot Ankle Surg 2016; 22:170-175. [PMID: 27502225 DOI: 10.1016/j.fas.2015.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/29/2015] [Accepted: 07/01/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Foot and ankle surgery has an increased incidence of post-operative surgical site infections. The aim of this study was to examine the efficacy and efficiency of an alternative method of surgical site preparation for foot and ankle surgery. METHOD Fifty-one volunteers were recruited for this study which compared standard gauze painting using 2% chlorhexidine with 70% alcohol to immersion of the foot and ankle in a non-sterile bag filled with 60mL of the same solution and rubbing all skin surfaces (bag immersion method). Each method was applied to different feet of each volunteer in a randomised order. Commercially available impression agar slides were used to measure bacteria colony-forming-unit (CFU) counts from four areas of each foot after allowing the preparation to dry. Outcomes included CFU count and preparation time. RESULT There was no difference between the methods in terms of CFU count (0 total CFU vs. 1). Preparation time was significantly shorter for the bag immersion method (63.98s vs. 67.98s). Two-side 90% confidence intervals (2.03-6.00) for the difference in means of preparation time demonstrated equivalence using a margin of ±20%. CONCLUSIONS The bag immersion method is a valid alternative, equivalent in preparation timing and the elimination of transient skin flora when using 2% Chlorhexidine with 70% alcohol.
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Affiliation(s)
- Alice Chang
- Department of Orthopaedic Surgery, The Sutherland Hospital, Sydney, New South Wales, Australia
| | - Adrian Hughes
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, New South Wales, Australia
| | - William du Moulin
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, New South Wales, Australia.
| | - Chinmoy Mukerjee
- Department of Microbiology, The St George Hospital, Sydney, New South Wales, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, New South Wales, Australia
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13
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Seigerman DA, Rivlin M, Bianchini J, Liss FE, Beredjiklian PK. A Comparison of Two Sterile Solution Application Methods During Surgical Preparation of the Hand. J Hand Surg Am 2016; 41:698-702. [PMID: 27083319 DOI: 10.1016/j.jhsa.2016.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/28/2016] [Accepted: 03/26/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the extent of skin coverage during surgical preparation of the hand when preparation is done by 2 different methods. We hypothesized that hand preparation with commercially available prep-stick applicators (PS) would lead to more unprepared areas (UPAs) of skin compared with immersed 4 × 4 inch sterile gauze sponges (GS) used as controls. METHODS Sixty upper extremities of 30 healthy volunteers were used for this study. The hands were prepped by 2 fellowship trained orthopedic hand surgeons as 30 matched pairs. The experimental group was prepped using a commercially available PS (ChloraPrep, Carefusion, San Diego, CA), whereas the control group was prepared with GS immersed in the prep solution and applied manually using sterile gloves. The number and location of UPAs in the hands and wrists of volunteers after preparation were recorded. In addition, the sum of UPAs relative to the total surface area of the skin was quantified with image analysis software. RESULTS There were a total of 77 UPAs when prepping the volunteers with PS, compared with 14 in the control hands. This difference was statistically significant. Similarly, the average percentage area of UPAs relative to the total skin surface was 0.76% (range, 0.006% to 2.15%) when using PS compared with 0.15% (range, 0.005% to 0.56%) in the controls. This difference was statistically significant. CONCLUSIONS We identified a larger numbers of UPAs with commercially available applicator sticks compared with a control using sterile GS. CLINICAL RELEVANCE The clinical implications of these findings are unknown.
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Affiliation(s)
- Daniel A Seigerman
- Department of Orthopaedic Surgery, Division of Hand Surgery, Rothman Institute, Jefferson Medical College, Philadelphia, PA
| | - Michael Rivlin
- Department of Orthopaedic Surgery, Division of Hand Surgery, Rothman Institute, Jefferson Medical College, Philadelphia, PA
| | - Justin Bianchini
- College of Biomedical Engineering, Drexel University, Philadelphia, PA
| | - Frederick E Liss
- Department of Orthopaedic Surgery, Division of Hand Surgery, Rothman Institute, Jefferson Medical College, Philadelphia, PA
| | - Pedro K Beredjiklian
- Department of Orthopaedic Surgery, Division of Hand Surgery, Rothman Institute, Jefferson Medical College, Philadelphia, PA.
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Creech CL, Malan JR, Meyr AJ. Evaluation of the Sagittal Saw Blade as an Intraoperative Fomite During Diabetic Foot Surgery. Foot Ankle Spec 2015; 8:279-83. [PMID: 25428180 DOI: 10.1177/1938640014560162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Surgical site infection is a major potential complication of all operative interventions, and the diabetic foot is particularly at risk for bacterial recontamination and infectious sequelae. The objective of this study was to identify whether the sagittal saw blade used during partial foot amputations and diabetic foot debridements carries the potential to serve as a bacterial fomite. We physically cultured the sagittal saw blade during 20 foot debridements involving the resection of bone in patients diagnosed with a diabetic foot infection. The culture was taken after the initial debridement and during the irrigation phase of the procedure. We observed 16 positive routine intraoperative culture results, with positive saw blade culture results in 15 (93.8%; 15/16) of these cases. In 14 (93.3%; 14/15) of these cases, the saw blade culture grew at least one of the same bacteria as our other routine intraoperative cultures. We observed 4 negative routine intraoperative culture results, with negative saw blade culture results in 3 (75.0%; 3/4) of these cases. This results in agreement between routine intraoperative cultures and saw blade culture of 85.0% (17/20). The results of this investigation demonstrate that the sagittal saw blade used for osseous resection during diabetic foot debridements and partial foot amputations carries the potential for intraoperative bacterial transmission. We recommend changing at least the sagittal saw blade if more bone is resected following irrigation, particularly if it is used to obtain a "clean margin" for microbiological or histological examination. LEVELS OF EVIDENCE Therapeutic, Level IV: Case series.
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Affiliation(s)
- Corine L Creech
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, Pennsylvania (CLC)Podiatric Surgical Residency Program, St Luke's Allentown Hospital, Allentown, Pennsylvania (JM)Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania (AJM)
| | - Jared R Malan
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, Pennsylvania (CLC)Podiatric Surgical Residency Program, St Luke's Allentown Hospital, Allentown, Pennsylvania (JM)Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania (AJM)
| | - Andrew J Meyr
- Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, Pennsylvania (CLC)Podiatric Surgical Residency Program, St Luke's Allentown Hospital, Allentown, Pennsylvania (JM)Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania (AJM)
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