Comparison of three preoperative skin preparation techniques in ponies

Abstract

Summary The purpose of this study was to evaluate the efficacy of 3 preoperative skin preparations (povidone‐iodine [PI] removed with 70% isopropanol, and 4% chlorhexidine gluconate [CG] removed with either 70% isopropanol [CA] or sterile saline solution [CS]) in ponies. Eighteen ponies were randomly assigned to one of the 3 preoperative skin preparation groups. The skin of ponies was aseptically prepared with PI removed with alcohol, or 4% CG removed with either alcohol or sterile saline solution. The antimicrobial efficacy of each skin preparation technique was assessed quantitatively by culturing for surface bacteria with replicating organism detection and counting plates. The percentage of negative cultures, the percentage of cultures with >5 colony forming units (CFU) and the percentage bacterial reduction after the cleansing scrub, the sterile scrub, and the surgical procedures were compared. There was a significant difference between CG and PI in percentage bacterial reduction after the cleansing scrub, but no significant difference at any other time (sterile scrub, post operative skin sampling). In a comparison of the number of negative microbial cultures at each sampling point, there were no significant differences among the 3 skin preparation techniques. There were no significant differences among the treatment groups comparing the number of cultures with a high colony count (>5 CFU) after the cleansing scrub. Skin preparation with CS and PI resulted in significantly fewer cultures with >5 CFU after the sterile scrub than CA. Post operatively, CA had a higher number of samples with >5 CFU than CS and PI. PI removed with alcohol and 4% CS are equally effective in the reduction of skin bacteria after a sterile skin scrub in the operating room; however, CG was more effective in reducing bacterial numbers after the cleansing scrub. The number of cultures with high bacterial counts was greater post operatively, when alcohol was used as a rinse with chlorhexidine. In cases where a sterile scrub is not performed following a cleansing scrub, CG may be a better choice than PI. CA should not be used as a presurgical skin preparation method in ponies.

Comparative efficacy of three antiseptics as surgical skin preparations in dogs

“…37,40 Most of the similar studies had an antiseptic included in the initial presurgical wash. 6,18,40 Our study is the only one to have reported skin reactions after the initial wash with a neutral detergent, and may thereby emphasize the role that washing alone or chemical detergents play in the development of skin reactions. Our study also had a higher prevalence of skin reactions (35%) when compared to other similar studies 6,16,18,40,90 This may be attributed to overzealous washing by inexperienced final year students performing the scrub. Because no dogs showed any significant differences in the grading of the cutaneous reactions between the wash and the application of the antiseptic, and the insignificant distribution of the skin reactions across the antiseptics, it is the author's opinion that the skin reactions were caused by the mechanical wash and not the application of the antiseptics.…”

“…27 Our study, however, differs from most of the other antiseptic trials in that only one antiseptic preparation procedure was performed. 16,18,37,40,90 The uniform post antiseptic reduction in CFU's of all the products to a median of zero proved that one application of antiseptic only, significantly dropped CFU counts.…”

Efficacy and dermal tolerance of a novel alcohol‐based skin antiseptic in horses

“…We selected a standard 5‐minute CHXG scrub as reference because this method is routinely used in our equine hospital. Although the sustained action of CHXG may be reduced by rinsing with 70% isopropyl alcohol, this protocol is common in many hospitals and other studies . We did not intend to test the residual action of antiseptics and, therefore, adopted this method of rinsing CHXG to maintain clinical applicability.…”

“…The protocol for microbiological testing is similar to that used in other veterinary studies that have compared the efficacy of antiseptic methods . However, we did not conduct preantiseptic microbiological sampling, which was used in other studies to calculate the percentage of CFU reduction . This design was selected because we sought to compare the activity of 4 skin antiseptic methods, not to establish the final efficacy of the methods in preventing SSI.…”

“…Aseptic preparation of the patient's skin is an essential step in the prevention of surgical site infections (SSI) . Many studies have attempted to establish the optimum preoperative skin preparation protocol for the patient, both human and veterinary, as well as for the surgeon . The variables most commonly investigated include minimum contact time required and product used.…”