Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery

Mastrocola, Mario; Matziolis, Georg; Böhle, Sabrina; Lindemann, Chris; Eijer, Henk

doi:10.1038/s41598-021-97838-8

Cited by 9 publications

(11 citation statements)

References 47 publications

(44 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…The majority of endogenous skin flora are associated with the superficial stratum corneum [ 10 , 61 ]. These are more successfully managed with the mechanical and chemical means of clinical PSPs [ 10 , 61 ]. Their eradication accounts for the considerable microbial reduction observed for clinical PSPs in FDA filings (>2 log 10 ).…”

Section: Discussionmentioning

confidence: 99%

“…Diverse antiseptic agents and protocols have since been devised for PSP; among the earliest included the use of chlorinated lime, carbolic acid, and boric acid [ 1 , 7 , 8 , 9 ]. Today, medical practitioners have largely settled on alternating scrubs of alcohol and solutions with either chlorhexidine gluconate (CHG) or the iodophor povidone iodine (PVP-I); these chemical agents strike a balance between rapid microbicidal activity and low toxicity to patients’ tissues [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…As these commonplace topical agents were developed throughout the mid-1900s, one of the pioneers of open-heart surgery poignantly reflected on the contemporary beliefs of the day regarding PSP procedures: “that by the use of surface agents perfection in the sterilization of skin (as in everything else) is impossible and must remain, as it always has been, a goal and a standard for relative comparison [ 11 ]”. Indeed, our current understanding of PSPs and their antimicrobial efficacy remains scarcely changed—a fact which has been recently reemphasized in a thorough 2021 meta-analysis of PVP-I and CHG PSPs which states, “Human skin cannot be sterilized even by intense disinfection [ 10 ]”.…”

Section: Introductionmentioning

confidence: 99%

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A Porcine Model for the Development and Testing of Preoperative Skin Preparations

et al. 2022

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Clinical preoperative skin preparations (PSPs) do not eradicate skin flora dwelling in the deepest dermal regions. Survivors constitute a persistent infection risk. In search of solutions, we created a porcine model intended for PSP developmental testing. This model employed microbiological techniques sensitive to the deep-dwelling microbial flora as these microorganisms are frequently overlooked when using institutionally-entrenched testing methodologies. Clinical gold-standard PSPs were assessed. Ten Yorkshire pigs were divided into two groups: prepared with either povidone iodine (PVP-I) or chlorhexidine gluconate (CHG) PSP. Bioburdens were calculated on square, 4 cm by 4 cm, full-thickness skin samples homogenized in neutralizing media. Endogenous bioburden of porcine skin (3.3 log10 CFU/cm2) was consistent with natural flora numbers in dry human skin. On-label PSP scrub kits with PVP-I (n = 39) or CHG (n = 40) failed the 2–3 log10-reduction criteria established for PSPs by the Food and Drug Administration (FDA), resulting in a 1.46 log10 and 0.58 log10 reduction, respectively. Porcine dermal microbiota mirrored that of humans, displaying abundant staphylococcal species. Likewise, histological sections showed similarity in hair follicle depths and sebaceous glands (3.2 ± 0.7 mm). These shared characteristics and the considerable fraction of bacteria which survived clinical PSPs make this model useful for developmental work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Porcine Model for the Development and Testing of Preoperative Skin Preparations

et al. 2022

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“…The occurrence of the infection prolongs hospital stays [3], and is associated with morbidity [4] and excess medical costs [5]. The main source of infection is suggested the normal skin flora of the skin [6]. Therefore, appropriate presurgical skin antisepsis of the surgical site is essential.…”

Section: Introductionmentioning

confidence: 99%

The role of skin antisepsis in upper extremity surgery to reduce surgical site infection: a comparison between single and triple regimens

Hwang

Lee

2022

Arch Hand Microsurg

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Purpose: No consensus is made for preoperative skin antisepsis for upper extremity surgery. We aimed to determine if the use of povidone-iodine only (single regimen) instead of povidone-iodine and alcohol-chlorhexidine (triple regimen) resulted in an increased rate of surgical site infection (SSI), and to detect any associated factors that increased the infection risk.Methods: A cross-sectional, retrospective review of medical records was made for patients who underwent upper extremity surgery from March 2020 and February 2021. Either single or triple regimen was used for preoperative skin antisepsis. Rate of SSI was compared through marked elevation of C-reactive protein (CRP) at 2 weeks after surgery, superficial SSI, and deep SSI. Logistic regression analysis was performed to find the associated factors for the SSI among the evaluated parameters.Results: Among 175 patients (male, 81 and female, 94), single regimen was used in 78 patients (44.6%) and triple regimen in 97 patients (55.4%). Single regimen (odds ratio [OR], 2.425; 95% confidence interval [CI], 1.040–5.655) and surgical procedure using metal implant (OR, 3.602; 95% CI, 1.184–10.953) were significantly associated with the marked CRP elevation at 2 weeks. However, there was no difference in SSI rates between single and triple regimen. Diabetes mellitus (OR, 6.636; 95% CI, 1.259–34.969) was the only associating factor with superficial SSI through logistic regression analysis.Conclusion: Our study suggests that single regimen maintained a longer CRP elevation compared to the triple regimen, but was similarly effective in preventing SSI for upper extremity surgeries.

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Does a Presurgical Antisepsis Protocol Decrease Surgical Site Infections in Young Children?

Lapp,

Ben Khallouq,

Bentley

et al. 2023

AORN Journal

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National standards for surgical site infection (SSI) prevention for children remain elusive. Our institution developed a presurgical antisepsis protocol that included the three components of chlorhexidine gluconate bathing wipes, chlorhexidine gluconate oral rinse, and povidone‐iodine nasal swab. This retrospective cohort study examined data from electronic health records to compare SSI rates before and after protocol implementation. We included children aged 2 through 11 years undergoing any surgical procedure with the use of an incision in the OR (N = 1,356). We did not find any difference in the occurrence of SSI before and after the protocol was implemented. Logistic regression showed that an infection present at the time of surgery was the only significant predictor of an SSI. The implementation of a presurgical antisepsis protocol was not associated with SSI rate reduction in this pediatric cohort.

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Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery

Cited by 9 publications

References 47 publications

A Porcine Model for the Development and Testing of Preoperative Skin Preparations

A Porcine Model for the Development and Testing of Preoperative Skin Preparations

The role of skin antisepsis in upper extremity surgery to reduce surgical site infection: a comparison between single and triple regimens

Does a Presurgical Antisepsis Protocol Decrease Surgical Site Infections in Young Children?

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