Skin asepsis protocols as a preventive measure of surgical site infections in dogs: chlorhexidine–alcohol versus povidone–iodine

Abstract

BackgroundMost of surgical site infections (SSI) are caused by commensal and pathogenic agents from the patient’s microbiota, which may include antibiotic resistant strains. Pre-surgical asepsis of the skin is one of the preventive measures performed to reduce SSI incidence and also antibiotic resistance dissemination. However, in veterinary medicine there is no agreement on which biocide is the most effective.The aim of this study was to evaluate the effectiveness of two pre-surgical skin asepsis protocols in dogs. A total of 46 animals were randomly assigned for an asepsis protocol with an aqueous solution of 7.5% povidone-iodine or with an alcoholic solution of 2% chlorhexidine. For each dog, two skin swab samples were collected at pre-asepsis and post-asepsis, for bacterial quantification by conventional techniques and isolation of methicillin-resistant species.ResultsMost samples collected at the post-asepsis did not present bacterial growth, both for the animals subjected to the povidone-iodine (74%) or to the chlorhexidine (70%) protocols. In only 9% of the cases a significant bacterial logarithmic reduction was not observed, indicating possible resistance to these agents. Also, the logarithmic reduction of the bacterial quantification from pre- and post-asepsis time, was not statistically different for povidone-iodine (6.51 ± 1.94 log10) and chlorhexidine (6.46 ± 2.62 log10) protocol.From the 39% pre-asepsis swabs which showed bacterial growth in MRSA modified chromogenic agar medium, only one isolate was identified as Staphylococcus aureus and one as S. epidermidis. False positives were mainly other staphylococci species, as well as Enterobacteriaceae.ConclusionsPre-surgical skin asepsis protocols with povidone-iodine or chlorhexidine showed similar efficacy in the elimination of methicillin resistant bacteria and preventing surgical site infections in dogs undergoing surgery.

Comparison of hydroalcoholic rubbing and conventional chlorhexidine scrubbing for aseptic skin preparation in dogs

“…8,32,33 Studies comparing different presurgical skin asepsis protocols in veterinary medicine are scarce. 9,10,12,29,30,[34][35][36][37][38] Commonly used methods involve a 5-minute preparation with mechanical scrubbing of the skin, during which the scrubbing procedure is repeated at least 3 times. [9][10][11][12] For our study design, CHX scrubbing was repeated 5 times because, in our hospital, we scrub twice in the preparation room and then 3 times in the operating room.…”

“…They also recommend the use of alcoholic antiseptic solutions that are based on chlorhexidine gluconate (CHXG) for surgical site skin preparation in patients undergoing a surgical procedure . In veterinary medicine, povidone‐iodine (PI) or CHX is generally used for skin antisepsis . Mechanical scrubbing of the skin for 5 minutes with CHXG followed by either a saline rinse or an alcohol rinse is one of the standard, commonly used methods of skin antisepsis for evaluating the efficacy of other protocols …”

“…[5][6][7][8] In veterinary medicine, povidoneiodine (PI) or CHX is generally used for skin antisepsis. [9][10][11][12] Mechanical scrubbing of the skin for 5 minutes with CHXG followed by either a saline rinse 10 or an alcohol rinse 12 is one of the standard, commonly used methods of skin antisepsis for evaluating the efficacy of other protocols. 10,12 To preserve the efficacy of antiseptic agents in controlling infections, it is essential to prevent the emergence of bacteria resistant to these compounds as well as cross resistance by using these antimicrobial compounds in an appropriate manner.…”

Surgical blades as bacteria dissemination vehicles in dogs undergoing surgery – a pilot study

“…All animals performed pre-surgical exams, including hepatological and biochemical parameters evaluation, namely complete blood count and serum determination of creatinine, urea, glucose, albumin, and hepatic enzymes (alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase), in order to exclude those animals with laboratory standard tests results deviated from the reference values. Of the 46 dogs, 23 were randomly selected to be submitted to a pre-surgery skin asepsis protocol with 7.5% povidone-iodine, and the remaining 23 to a presurgery skin asepsis protocol with an alcoholic solution of 2% chlorhexidine, as previously described [12]. Surgical team preparation was performed according to former reports [13,14].…”

Prevention and surveillance of surgical infections: A review

“…There are many different biocides available for preparation of surgical sites, including povidone iodine, chlorhexidine, and alcohol‐based solutions, all of which have been shown to have an equivalent impact on bacterial growth on the skin . In addition, povidone iodine and chlorhexidine solutions reportedly decrease the occurrence of SSI among dogs undergoing orthopedic or soft tissue surgery . Many factors may contribute to the efficacy of presurgical scrubs, and, variable efficacies are reported.…”