Intraoperative Disinfection by Pulse Irrigation with Povidone-Iodine Solution in Spine Surgery

Abstract

Background Deep wound infection in spine surgery is a debilitating complication for patients and increases costs. The objective of this prospective study was to evaluate the efficacy of wound pulse irrigation with a dilute povidone-iodine solution in the prevention of surgical site infection. Methods 50 patients undergoing spinal surgery were randomly divided into two groups (A and B) of 25 patients each. In group A, wounds were irrigated with dilute (3%) povidone-iodine solution through a low-pressure pulsatile device. In group B, wounds were irrigated with saline solution through a bulb syringe. In both groups, specimens for bacterial culture were harvested from surgical site before and after irrigation. Results In group A, no surgical site infection occurred; in group B, deep wound infection was observed in 3 patients. In both groups, before irrigation some cultures have been found positive for bacterial contamination. Conclusion Our study seems to support the idea that low-pressure pulsating lavage of surgical wounds with povidone-iodine diluted to a nontoxic concentration of 3% is an effective therapeutic adjunct measure to prevent surgical site infection in spine surgery. However, the number of the enrolled patients is small and a significant statistical analysis is not practicable. This trial is registered with NCT03249363.

Intrawound Treatment for Prevention of Surgical Site Infections in Instrumented Spinal Surgery: A Systematic Comparative Effectiveness Review and Meta-Analysis

“…Fourteen studies provided a clear definition of SSI. In 5 studies, 32,44–46,48 this was the (deep) SSI definition used by the Centers for Disease Control and Prevention. 50 Three studies defined SSI as a combination of clinical symptoms, elevated serum inflammation markers (erythrocyte sedimentation rate, C-reactive protein, white blood cell count), and bacterial culture results.…”

“…Of the 20 included studies, 2 were RCTs 30,31 and 18 were observational cohort studies (Table 1). 32 –49 Eight studies investigated many different types of spinal surgery. 30,38 –41,43,46,47 Five studies investigated deformity surgery, in either adults, 42 children, 45,48,49 or both.…”

“…30,[38][39][40][41]43,46,47 Five studies investigated deformity surgery, in either adults, 42 children, 45,48,49 or both. 32 One study investigated all types of spinal surgery in children. 44 Three studies investigated cervical spinal surgery, 34,36,37 and 3 studies investigated thoracolumbar or lumbar spinal surgery.…”

“…31,33,35 Sixteen studies investigated the use of intrawound antibiotics (all studies investigated vancomycin), 30,[33][34][35][36][37][38][39][40][41][42][44][45][46][47][48] while 4 studies investigated the use of intrawound irrigation with antiseptics (all studies investigated povidone-iodine, one study also added hydrogen peroxide). 31,32,43,49 Baseline equivalence regarding characteristics between control and intervention groups was present in 11 studies [30][31][32][33][34][35][37][38][39]47,49 and unclear or not present in 9 studies. 36,[40][41][42][43][44][45][46]48 Characteristics of the intervention treatments and the use of perioperative antibiotic prophylaxis can be found in Table 2.…”

Prediction tool for high risk of surgical site infection in spinal surgery

“…Many infection control measures, recommended for every surgery with sufficient evidence, have been tried, yet other measures that have also shown effectiveness are not commonly used because their application has been limited to spinal surgery cases only, with low evidence levels. Several studies have demonstrated infection prevention interventions to reduce infection rates in patients undergoing spinal surgeries, including irrigation with povidoneiodine solution, 6,7 prophylactic vancomycin administration, 8,9 and intrawound vancomycin powder. 10,11 However, applying complex and expensive infection prevention interventions in every patient undergoing surgery may result in poor allocation of limited human, temporal, and medical resources.…”