Iodine-impregnated incision drape and bacterial recolonization in simulated total knee arthroplasty

Abstract

Background and purposeIodine-impregnated incision drapes (IIIDs) are used to prevent surgical site infection (SSI). However, there is some evidence to suggest a potential increase in SSI risk as a result of IIID use, possibly from promotion of skin recolonization. A greater number of viable bacteria in the surgical field of an arthroplasty, and surgery in general, may increase the infection risk. We investigated whether IIID use increases bacterial recolonization compared to no drape use under conditions of simulated total knee arthroplasty (TKA).Methods20 patients scheduled for TKA were recruited. Each patient had 1 knee randomized for draping with IIID, while the contralateral knee was left bare. The patients thus served as their own control. The operating room conditions and perioperative procedures of a TKA were simulated. Cylinder samples were collected from the skin of each knee prior to disinfection, and again on 2 occasions after skin preparation—75 min apart. Quantities of bacteria were estimated using a spread plate technique under aerobic conditions.ResultsWe found similar quantities of bacteria on the intervention and control knees immediately after skin disinfection and after 75 min of simulated surgery. These quantities had not increased at the end of surgery when compared to baseline, so no recolonization was detected on the draped knees or on the bare knees.InterpretationThe use of IIIDs did not increase bacterial recolonization in simulated TKA. This study does not support the hypothesis that IIIDs promote bacterial recolonization and postoperative infection risk.

Prevention of periprosthetic joint infection

“…55 Guidelines: The WHO and CDC do not feel that draping the area of the incision is necessary, based on low quality evidence (weak recommendation). 6,7 There are, however, current studies 5,51,53 which show that draping the area may reduce SSI. Normothermia and oxygenation.…”

“…51 The use of drapes without antiseptic agents has been shown to increase the risk of SSI. 52,53 NICE recommend the use of iodine impregnated drapes, 9 and recent studies support their use. 51,54 Nevertheless, the issue regarding the use of draping the area of the incision in general and the need for draping with bactericidal or bacteriostatic agents remains unresolved.…”

The Effectiveness of Sterile Wound Drapes in the Prevention of Surgical Site Infection in Thoracic Surgery

“…Although the length of stay in hospital was the same, the cost was reduced, because the number of SSIs was lower, with an associated reduction in expensive treatments such as debridement and VAC. In a study by Milandt et al [17], it was reported that bacterial recolonization did not increase in patients who underwent bilateral knee arthroscopy. Bilateral surgery is a factor that increases the operation time.…”

Does the type of surgical drape (disposable versus non-disposable) affect the risk of subsequent surgical site infection?

“…There is debate within the literature as to whether these drapes offer any significant protection against SSI. [10][11][12][13][14][15][16][17] In addition, we did not review skin edge protection devices as these are only used in other surgical disciplines such as the wound protection devices (WPD) used in general surgery. However, there is growing evidence that the incised skin edge harbours bacteria which is not cleared by standard skin preparation or occluded by incision drapes and therefore the importance of decontaminating or occluding the skin edge requires further investigation.…”

“…Most notably would be the patient's skin, which can be partially occluded by adhesive plastic dressings, or more importantly the skin edges of the incision which harbour pathogens unable to be cleared by pre-operative antibiotics or standard skin preparation or occluded by adhesive plastics. [10][11][12][13][14][15][16][17][18][19][20] Alternative sources of bacteria include the surgical team, the instruments, the air or the adjunctive equipment such as the c-arm, microscope or robot. [21][22][23][24][25][26][27][28] The Cochrane review of randomised controlled trials by Webster and Alghamdi examined whether plastic adhesive drapes (alone or in combination with either reusable or displosable drapes) lowered the rate of infection in all types of surgery.…”