Bacterial Colonization of the Skin Following Aseptic Preoperative Preparation and Impact of the Use of Plastic Adhesive Drapes

Abstract

Surgical site contamination, for example, with coagulase-negative staphylococci, probably derives from both the patient's own skin flora and those of the surgical team. Despite preoperative antiseptic preparation with chlorhexidine solution, complete sterilization of the skin is not possible and gradual recolonization will occur. Plastic adhesive drape is an established method used to prevent direct wound contamination from adjacent skin. In this study, the time to skin recolonization after antiseptic preparation was measured and the impact of using plastic adhesive drape on this recolonization was evaluated. Repeated bacterial sampling using three different methods over 6 hr was conducted after antiseptic preparation in 10 volunteers. Recolonization of skin was observed after 30 min with plastic drape and after 60 min without plastic drape; there were significantly more positive cultures with the plastic drape than without (31% vs. 7.5%, respectively, p < .001). Sampling with a rayon swab was the most sensitive sampling method. In conclusion, covering the skin with a plastic adhesive drape seems to hasten recolonization of the skin after antiseptic preparation. However, clinical trials to confirm this finding are warranted.

Topical benzoyl peroxide application on the shoulder reduces Propionibacterium acnes : a randomized study

“…Furthermore one may anticipate that there is a correlation between P. acnes on the skin from swabs and in the deeper layers but that has not to our knowledge been shown; reduction of the latter probably being clinically important. A larger study population could have shown differences in the CHS-group, but our findings on this subject are consistent with those of other studies 9,15,20,23,25 . Quantification of colonizing bacteria on the skin pre-operatively has often been used as a marker for risk of post-operative infection, but how well it really corresponds to risk for infections for different bacterial species is not so well studied.…”

Prevention methodologies against infection after total joint arthroplasty

“…This review of seven trials showed that adhesive drapes did not reduce surgical site infections when compared with nonadhesive drapes, and may have had the opposite effect. In a study of 10 healthy volunteers by Falk-Brynhildsen et al, 58 bacterial recolonization on aseptically prepared skin was compared between volunteers who were draped with adhesive plastic drapes and those who were not draped. They found significantly more positive cultures in the patients who had the drapes than in patients without drapes (31% and 7.5%, respectively; P ¼ 0.001), indicating that adhesive nylon drapes may actually hasten recolonization after skin preparation.…”

Operative Environment

“…However, another experimental study on an animal model found that after contamination of skin samples with S. aureus suspension, iodine‐containing adhesive drapes were as inefficient as the control group in reducing the number of colony‐forming units . Another experimental study found that non‐impregnated drapes can facilitate the rate of recolonization of skin after antiseptic preparation . In contrast, in an earlier investigation, bacteria did not multiply underneath a plastic adhesive drape and lateral migration of bacteria did not occur …”