Randomised comparison of two skin preparation methods in foot and ankle surgery

Chang, Alice S.; Hughes, Andrew; Moulin, William du; Mukerjee, Chinmoy; Molnar, Robert

doi:10.1016/j.fas.2015.07.001

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…The bag immersion technique, in which the foot is immersed in a solution, has been studied by many authors with varying results. 4,11,15 Chang et al 11 randomized 51 healthy volunteers to a chlorhexidine bag immersion technique or a standard alcohol and chlorhexidine preparation, finding that that the bag immersion technique did not offer any benefit in terms of the rate of positive skin culture swabs. On the other hand, Dingemans et al, 15 in a similar study of 22 healthy volunteers, found that bag immersion in an alcoholonly solution followed by chlorhexidine and alcohol painting resulted in a lower rate of positive skin culture swabs from the subungual area than chlorhexidine and alcohol painting alone.…”

Section: Discussionmentioning

confidence: 99%

“…Extensive a priori internal discussions among the authors determined that a reduction in the rate of positive cultures by half (to 15%) would be an appropriate threshold for clinical significance. This was based on a combination of a review of similar studies comparing antisepsis solutions, 5,8,11,[16][17][18] as well as the authors' determination that a decrease of this magnitude would be the threshold at which they would be willing to modify their own clinical practice. Using these parameters, in order to have 80% power to show a clinically significant reduction, while allowing for a type I error rate of 5%, a total of 242 patients would need to be enrolled.…”

Section: Sample Size Calculationmentioning

confidence: 99%

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Randomized Trial of Dilute Povidone-Iodine Soak and Scrub for Orthopaedic Foot and Ankle Surgery

et al. 2021

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Background: There is no consensus as to which skin antiseptic solution is most effective at reducing infection following orthopedic foot and ankle surgery. The purpose of this study is to determine if the addition of a dilute povidone-iodine soak and scrub to a standard preparation with alcohol and chlorhexidine decreases positive bacterial culture rates from the hallux nailfold. Methods: In this prospective, randomized controlled trial, 242 subjects undergoing orthopedic foot and ankle surgery were randomized to one of 2 groups. The control group received our standard 2-step skin antiseptic preparation of an alcohol scrub (step 1) followed by chlorhexidine/alcohol paint (step 2). The intervention group received a 3-minute dilute povidone-iodine soak and scrub followed by that same standard 2-step skin preparation. Immediately before skin incision, culture swabs were taken from the hallux nailfold of both groups. Results: Of the 257 subjects enrolled and randomized, 242 (94.2%) completed the study, satisfying the a priori sample size requirement of 242 subjects. There were no crossovers between groups. There were no differences in baseline characteristics between groups ( P > .05 for each). There was no difference in bacterial growth rates between groups (26.8% growth in the intervention group vs 26.9% growth in the control group, P = .991). Conclusion: The hallux nailfold is one of the most difficult to sterilize areas prior to orthopedic foot and ankle surgery. This randomized controlled trail found no benefit to adding a 3-minute dilute povidone-iodine soak and scrub to a standard skin preparation with alcohol and chlorohexidine. Level of Evidence: Level I, randomized controlled trial.

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Section: Discussionmentioning

confidence: 99%

Section: Sample Size Calculationmentioning

confidence: 99%

Randomized Trial of Dilute Povidone-Iodine Soak and Scrub for Orthopaedic Foot and Ankle Surgery

et al. 2021

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“…Authors have reported varied results on the effectiveness of immersing the foot in a cleansing solution (Figure 1) as an alternative to or in conjunction with the standard paint and scrub application techniques. For example, Chang et al 10 randomized 51 healthy volunteers into 1 of 2 application groups (level I evidence) ( Table 2). The subjects in the first group had their lower extremity below the knee immersed for 5 minutes in a nonsterile bag containing a 60-mL solution of 2% CHG in 70% ethanol.…”

Section: Bag Immersion Methodsmentioning

confidence: 99%

Skin Preparation Techniques for Orthopedic Foot and Ankle Surgery: A Current Concepts Review

et al. 2020

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Surgical site infection (SSI) following orthopedic foot and ankle surgery is associated with morbidity, mortality, and cost to the healthcare system. The local anatomy and physiology predispose patients undergoing procedures to elevated risk. In particular, sterilizing of the webspaces, nailfolds, and subungual areas presents challenges, and the preferred skin antisepsis technique for foot and ankle procedures has not yet been defined. Skin antiseptic solutions (SASs) consist of 3 main categories: alcohol, chlorhexidine, and iodine-based solutions. This review of the literature supports a combined chlorhexidine and alcohol preparation technique; however, there are a number of studies that suggest otherwise. In addition, there is variable evidence for the use of alternatives to the standard soft sponge application technique, including immersion, bristled brush, and cotton gauze application. These alternatives may have a particular advantage in the forefoot. Most studies to date use growth from skin swab cultures after skin preparation as the primary outcome. Higher-level studies with large subject populations and more meaningful clinical outcomes will be required to solidify guidelines for preoperative skin antisepsis prior to foot and ankle procedures. Level of Evidence: Level V, expert opinion.

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Is short term intraoperative application of disinfectants harmful to breast implants in breast reconstruction? An experimental study and literature survey

Schmitz

Schubert

Kaschta

et al. 2019

Journal of the Mechanical Behavior of Biomedical Materials

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Randomised comparison of two skin preparation methods in foot and ankle surgery

Cited by 3 publications

References 19 publications

Randomized Trial of Dilute Povidone-Iodine Soak and Scrub for Orthopaedic Foot and Ankle Surgery

Randomized Trial of Dilute Povidone-Iodine Soak and Scrub for Orthopaedic Foot and Ankle Surgery

Skin Preparation Techniques for Orthopedic Foot and Ankle Surgery: A Current Concepts Review

Is short term intraoperative application of disinfectants harmful to breast implants in breast reconstruction? An experimental study and literature survey

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