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Comparison of the antimicrobial efficacy of povidone-iodine-alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic skin flora of the shoulder region.
Dörfel, D, Maiwald, M, Daeschlein, G, Müller, G, Hudek, R, Assadian, O, Kampf, G, Kohlmann, T, Harnoss, JC, Kramer, A
Antimicrobial resistance and infection control. 2021;(1):17
Abstract
BACKGROUND Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery. We hypothesized that prolonged skin preparation with an agent that penetrates deeply into the skin would be beneficial. Thus, we compared two classes of antiseptics, each combined with alcohol, each applied with two different contact times. METHODS Using a cross-over arrangement, shoulders of 16 healthy volunteers were treated for 2.5 min (standard) or 30 min (prolonged) with alcohol-based chlorhexidine (CHG-ALC) or alcohol-based povidone-iodine (PVP-I-ALC). Skin sites were sampled before, immediately after, and 3 h after treatment, using a standardized cup-scrub technique. RESULTS Aerobic skin flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after 2.5 min application and immediate sampling (reduction factor [RF] 2.55 ± 0.75 vs. 1.94 ± 0.91, p = 0.04), but not after prolonged contact times and 3-h sampling. Coagulase-negative staphylococci were completely eliminated after PVP-I-ALC application, but still recovered from 4 of 32 samples after CHG-ALC application. Anaerobic flora was reduced more effectively by PVP-I-ALC than CHG-ALC after standard (RF 3.96 ± 1.46 vs. 1.74 ± 1.24, p < 0.01) and prolonged (RF 3.14 ± 1.20 vs. 1.38 ± 1.16, p < 0.01) contact times and immediate sampling, but not after 3-h sampling. No adverse events were reported. CONCLUSIONS PVP-I-ALC showed marginal benefits concerning the aerobic flora, but more substantial benefits over CHG-ALC concerning the anaerobic flora of the shoulder. Standard and prolonged contact times showed superiority for PVP-I-ALC for anaerobic flora at all immediate sampling points, but missed significance at 3-h sampling. The results underscore the need for protection against C. acnes and coagulase-negative staphylococci in orthopaedic surgery. The clinical relevance of these findings, however, should be studied with SSI as an endpoint.
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Comparison of olanexidine versus povidone-iodine for preventing surgical site infection in gastrointestinal surgery: study protocol for a multicentre, single-blind, randomised controlled clinical trial.
Takeuchi, M, Obara, H, Kawakubo, H, Shinoda, M, Okabayashi, K, Mayanagi, S, Irino, T, Fukuda, K, Nakamura, R, Wada, N, et al
BMJ open. 2019;(5):e028269
Abstract
INTRODUCTION The prevalence of surgical site infection (SSI) remains higher in gastrointestinal surgery than in other surgeries. Although several guidelines have indicated the efficacy of chlorhexidine and povidone-iodine in reducing the SSI rate, the optimal recommendation has still not been established. Therefore, it is necessary to determine the more effective antiseptic for surgical site preparation. Olanexidine (1.5% olanedine, Otsuka Pharmaceutical Factory, Tokushima, Japan), which is a new antiseptic in Japan, has antimicrobial activity against a wide range of bacteria, including Gram-positive and Gram-negative bacteria. Our study will contribute to determining a new antiseptic for use in gastrointestinal and other surgeries. METHODS AND ANALYSIS We propose a multicentre, randomised controlled clinical trial for comparing two treatments, that is, 1.5% olanexidine or 10% povidone-iodine, for surgical skin preparation to prevent SSI in clean-contaminated gastrointestinal surgeries with surgical wounds. Patients aged ≥20 years at the time of consent will be included. The primary outcome measure is the 30-day postoperative SSI rate. For the primary analysis, which is aimed at comparing the treatment effects, the adjusted risk ratio and its 95% CI will be estimated using the Mantel-Haenszel method. ETHICS AND DISSEMINATION The protocol was first approved by the Institutional Review Board of Keio University School of Medicine, followed by the institutional review board of each participating site. Participant recruitment began in June 2018. The final results will be published in international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER UMIN 000031560; Pre-results.
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Chlorhexidine 0.5%/70% Alcohol and Iodine 1%/70% Alcohol Both Reduce Bacterial Load in Clean Foot Surgery: A Randomized, Controlled Trial.
Shadid, MB, Speth, MJGM, Voorn, GP, Wolterbeek, N
The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2019;(2):278-281
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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Evaluation of three experimental in vitro models for the assessment of the mechanical cleansing efficacy of wound irrigation solutions.
Klasinc, R, Augustin, LA, Below, H, Baguhl, R, Assadian, O, Presterl, E, Kramer, A
International wound journal. 2018;(1):140-147
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Abstract
The aim of this study was to compare different wound-rinsing solutions to determine differences in the efficiency and to evaluate three different in vitro models for wound cleansing. Different wound-rinsing solutions (physiological saline solution, ringer lactate solution for wound irrigation, water and a solution containing polihexanide and the surfactant undecylenamidopropyl-betain) were applied on standardised test models (one- and three-chamber model, flow-cell method and a biofilm model), each challenged with three different standardised wound test soils. In the one-chamber model saline showed a better effect on decontaminating proteins than the ringer lactate solution. In the flow-cell method, water performed better than physiological saline solution, whereas ringer lactate solution demonstrated the lowest cleansing effect. No obvious superiority between the two electrolyte-containing solutions was detectable in the biofilm model. Unfortunately, it was not possible to assess the protein decontamination qualities of the surfactant-containing solution because of the interference with the protein measurement. The flow-cell method was able to detect differences between different rinse solutions because it works at constant flow mechanics, imitating a wound-rinsing procedure. The three-chamber and the less-pronounced modified one-chamber method as well as the biofilm model had generated inhomogeneous results.
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A contrast study of Dermacyn on enterocoely irrigate to control intraoperative infection.
Liu, J, Fan, P, Chu, J, Yang, J, Yang, X, Zhang, L, Guo, C
Minerva chirurgica. 2017;(2):121-124
Abstract
BACKGROUND To evaluate antimicrobial properties of Dermacyn in abdominal infections, and to develop a new method for peritoneal lavage without using antibiotics. METHODS One hundred and ten patients suffering from intestinal perforation (abdominal closed injury), who had been treated with opened surgical repair or partial intestinal resection, were enrolled in this study. In the study group, Dermacyn was used for peritoneal lavage. During the same period, 102 patients with intestinal perforation of abdominal closed injury and opened repair or partial intestinal resection were enrolled as a control group. For the control group, metronidazole physiological saline was used for peritoneal lavage. Patients from both groups had a postoperative indwelling peritoneal drainage tube. Five objective indicators were studied and compared at 24, 48, and 72 hours: volume of drainage, drainage fluid culture, blood routine test, C-reactive protein, calcitonin and antibiotics dose. RESULTS There were no significant differences between the drainage volumes in two groups three days after the operation. There were significant differences in the nature of the drainage fluid, bacterial culture results, blood routine, C-reactive protein and procalcitonin between the two groups. In the experimental group, after the Dermacyn flushing, the average volume of peritoneal drainage fluid was reduced (from 30 to 5 mL) from 24 to 72 hours postoperatively. CONCLUSIONS The use of Dermacyn as an antibiotic agent for intraoperative peritoneal lavage was effective in reducing the risk of infection, due to its broad-spectrum bactericidal effect. Dermacyn could be used safely to perform peritoneal flushing to clean the operation site.
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Usefulness of nasal packing with silver-containing carboxy methylated cellulose in endonasal sinus surgery.
Akiyama, K, Karaki, M, Yonezaki, M, Goto, R, Inamoto, R, Hoshikawa, H, Mori, N
Auris, nasus, larynx. 2014;(3):264-8
Abstract
OBJECTIVE Silver-containing carboxymethylcellulose fiber dressing (Aquacel®-Ag) has been used to treat burns and ulcers with a large amount of exudate. The aim of this investigation was to confirm whether Aquacel®-Ag has beneficial effects when it is used as nasal packing. METHODS We included 44 patients who underwent bilateral endoscopic sinus surgery due to chronic rhino-sinusitis. Beschitin-F® or Aquacel®-Ag was packed postoperatively into the bilateral middle meatus. Patient's comfort was recorded using a VAS, as well as wound healing, postoperative bleeding and local infection. Postoperative-specific organisms were also evaluated from the removed packing materials located in the middle meatus when they were removed on the 4th day after surgery. RESULTS The scores for nasal obstruction and pain were not statistically different in each group. Postoperative bacteriologic studies indicated marked differences. Coagulase-negative staphylococci were predominant and potential pathogens were recovered in a few cases in the Aquacel®-Ag group. In contrast, potential pathogens, including Streptococcus pneumonia, Haemophilus influenza, and Gram-negative rods, were predominant in the Beschitin-F® group. CONCLUSION The results indicate that Aquacel®-Ag might contribute to hemostasis, wound healing, and patient comfort after endonasal surgery, similar to Beschitin-F®. Additionally, it may have advantages concerning the prevention of postoperative infection.
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Comparing a combination of penicillin G and gentamicin to a combination of clindamycin and amikacin as prophylactic antibiotic regimens in prevention of clean contaminated wound infections in cancer surgery.
El-Mahallawy, HA, Hassan, SS, Khalifa, HI, El-Sayed Safa, MM, Khafagy, MM
Journal of the Egyptian National Cancer Institute. 2013;(1):31-5
Abstract
BACKGROUND AND AIM Appropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of surgical site infection (SSI) after a clean contaminated cancer surgery. Our aim is to compare the use of two prophylactic antibiotic (PA) regimens as regards efficacy, timing, and cost. PATIENTS AND METHODS Two hundred patients with gastric, bladder, or colorectal cancer were randomized to receive preoperative PA, group A received penicillin G sodium and gentamicin and group B received clindamycin and amikacin intravenously. The demographic data of patients were collected, and they were observed for wound infections. RESULTS Infected wounds occurred in 19 patients with a rate of 9.5%. Highest incidence of SSI was among bladder cancer patients (14.2%); p=0.044. The rate of SSI was 11% in group A, and 8% in group B, p=0.469. The cost of PA administered in group A was significantly less than that of group B (21.96±3.22LE versus 117.05±12.74LE, respectively; p<0.001). SSI tended to be higher among those who had longer time for antibiotic and incision (≥30min) than those who had shorter time interval (<30min), (13% vs. 6.5%, respectively). CONCLUSION Both penicillin+gentamicin and clindamycin+amikacin are safe and effective for the prevention of SSI in clean contaminated operative procedures. In a resource limited hospital, a regimen including penicillin+gentamicin is a cost-effective alternative for the more expensive and broader coverage of clindamycin+amikacin. Timing of PA is effective in preventing SSIs when administered 30min before the start of surgery.
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Visibility of surgical site marking: a prospective randomized trial of two skin preparation solutions.
Thakkar, SC, Mears, SC
The Journal of bone and joint surgery. American volume. 2012;(2):97-102
Abstract
BACKGROUND An important component of the surgical time-out is to confirm surgical site skin markings to prevent wrong-site surgery. Different skin preparation solutions may have variable effects on the visibility of site markings after application. We performed a prospective randomized clinical trial to quantitatively and qualitatively evaluate the visibility of surgical site markings after the use of two commonly available skin preparation solutions. METHODS We enrolled twenty patients undergoing primary total hip arthroplasty at our institution. Preoperatively, a black permanent marker was used to mark the skin of each patient with a random combination of three letters, underlined by a single black line, and with the surgeon's initials. Patients were randomly selected to receive a chlorhexidine-based or an iodine-based skin preparation according to manufacturer guidelines. The skin markings were photographed digitally, before and after the application of solution. The photographs made after the application of solution were assessed quantitatively, by calculating the contrast (marker to skin) before and after the application of the solutions, and qualitatively by ten orthopaedic surgeons to identify the random initials and to recognize skin markings. RESULTS The mean change in contrast level after application of the chlorhexidine-based solution was significantly greater than that after application of the iodine-based solution (mean and standard deviation, 59.8 ± 15.7 U versus 14.9 ± 11.4 U, respectively; p < 0.0001). Surgeons were an average of twenty-two times less likely (95% confidence interval, eight to sixty-eight) to judge markings as acceptable for site identification after preparation with the chlorhexidine-based solution than after preparation with the iodine-based solution. When examining individual letters, the surgeons correctly identified 296 of 300 letters in the group prepared with the iodine-based solution and 209 of 300 letters in the group prepared with the chlorhexidine-based solution; the difference was significant (p < 0.0001). CONCLUSIONS The use of the chlorhexidine-based solution for skin preparation resulted in significantly greater erasure of the surgical site marking than did the use of the iodine-based solution.
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Open versus laparoscopic appendectomy in the pediatric population: a literature review and analysis of complications.
Esposito, C, Calvo, AI, Castagnetti, M, Alicchio, F, Suarez, C, Giurin, I, Settimi, A
Journal of laparoendoscopic & advanced surgical techniques. Part A. 2012;(8):834-9
Abstract
BACKGROUND This study aims to compare the results of laparoscopic and open appendectomy (LA and OA, respectively) in a pediatric population with particular attention to complications analysis. SUBJECTS AND METHODS A literature search was performed using Medline, Cochrane, Embase, Sci Search, Lilacs, and PubMed databases on all studies published during the 14-year interval of 1997-2010. Comparative studies of LA versus OA in the pediatric population were included in these studies. Data concerning operative time, length of hospital stay, postoperative complications, postoperative pain, and surgical trauma were recorded. RESULTS We recorded 52 studies, but 26 of these were excluded from our analysis because they were neither relevant nor related to the adolescent population. The 26 studies analyzed showed a population of 123,628 children and adolescents (ages 0-18 years) who underwent appendectomy by laparoscopic (LA, 42,213 [34.1%]) and open (OA, 81,415 [65.9%]) techniques. Our analysis showed that patients undergoing LA presented a lower incidence of surgical wound infection, lower incidence of postoperative ileus, a lower use of analgesics in the postoperative period, an earlier resumption of normal diet, a shorter hospitalization, and a more rapid recovery to resume normal activities compared with patients undergoing OA. This study, comparing LA versus OA in children, failed to identify any major difference between the two techniques in terms of formation of intra-abdominal abscesses. As for operative time, our analysis showed globally a significant reduced operative time in OA versus LA in complicated appendicitis, but in simple appendicitis the operative time seems to be the same. CONCLUSIONS Our analysis of the literature showed that the LA technique presents several advantages compared with the OA technique. For this reason, if a child is hospitalized today for appendicitis treatment in a pediatric center where the laparoscopic approach is unavailable, he or she should be placed on antibiotics and transferred to a center that offers the laparoscopic approach.
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Comparison of two preoperative skin antiseptic preparations and resultant surgical incise drape adhesion to skin in healthy volunteers.
Grove, GL, Eyberg, CI
The Journal of bone and joint surgery. American volume. 2012;(13):1187-92
Abstract
BACKGROUND Adhesion of incise drapes is important at the wound edge, where the skin and drapes are contiguous with the wound. Separation of incise drapes from the skin has been reported to be associated with a sixfold increase in the infection rate compared with surgical procedures in which the drape did not lift off. The present study sought to determine whether the choice of preoperative skin preparation affects the adhesion of various incise drapes. METHODS Following randomization, the backs of twenty-two healthy volunteers were prepared with two skin preparations, 3M DuraPrep Surgical Solution Patient Preoperative Skin Preparation or ChloraPrep with Tint (Scrub Teal) Patient Preoperative Skin Preparation, according to the label directions. Sample strips (12.7 × 76.2 mm) of three different drapes were applied to the prepared areas and were covered with gauze soaked with saline solution for thirty minutes to simulate a fluid challenge. Drape samples were mechanically removed with use of a peel tester based on an international standard for testing peel adhesion of pressure-sensitive tape. Adverse events were monitored and the skin condition was observed. The primary outcome was drape adhesion, measured as the peel strength in units of gram-force. Outcomes were assessed according to drape type and skin preparation with use of mixed-model analysis of variance. RESULTS Skin prepared with DuraPrep solution had significantly greater drape adhesion (mean peel strength, 181 gf) compared with skin prepared with ChloraPrep (79 gf, p < 0.001). Although maintaining good adhesion is important, an incise drape that has excessive adhesion may cause skin irritation. Regardless of the skin preparation used, the skin reaction at the application site ranged from none to moderate erythema, and in no instance constituted an adverse event that required treatment. CONCLUSIONS The data suggest that the type of skin preparation affects drape adhesion. For surgical procedures in which incise drapes are used, choosing a skin preparation that enhances drape adhesion may minimize drape lifting and the potential for wound contamination.