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Ito Y, Nojiri S, Iwanaga N, Kawano S, Noro T, Machida M, Watanobe I, Sugo H. Incisional surgical site infections by subcutaneous soaking of wound with aqueous 0.05% chlorhexidine gluconate in gastroenterological surgery: A randomized controlled trial. Surgery 2024; 176:803-809. [PMID: 38876900 DOI: 10.1016/j.surg.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/22/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Chlorhexidine gluconate solution is superior to povidone-iodine for prevention of surgical site infection. However, the overall efficacy of chlorhexidine gluconate for surgical site infection prevention in various types of gastroenterological surgery, as well as the optimal concentration of chlorhexidine gluconate, remain unclear. The aim of the present study was to clarify whether subcutaneous wound soaking with chlorhexidine gluconate would reduce the incidence of surgical site infection associated with gastroenterological surgery in patients with wound classes Ⅱ to Ⅳ. METHODS Patients were randomly assigned (1:1) to either wound soaking with chlorhexidine gluconate (chlorhexidine gluconate group) or no chlorhexidine gluconate soaking (control group). After closure of the abdominal fascia, gentle subcutaneous soaking of the wound was performed using gauze fully soaked in aqueous 0.05% chlorhexidine gluconate before skin closure. Incisional surgical site infection was diagnosed using the Centers for Disease Control and Prevention criteria. The primary end point was the occurrence of incisional surgical site infection. RESULTS Among 363 patients, 245 (67%) underwent laparoscopic surgery. All 363 patients were included-181 in the chlorhexidine gluconate group (49.9%) and 182 (50.1%) in the control group. There were no significant inter-group differences in patient background, the type of procedure, or wound classification. The incidence proportion of incisional surgical site infection was significantly lower in the chlorhexidine gluconate group than in the control group (9.4% vs 19.2%; P = .008). CONCLUSION Subcutaneous wound soaking with chlorhexidine gluconate reduces the incidence of incisional surgical site infection in patients undergoing gastroenterological surgery.
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Affiliation(s)
- Yuzuru Ito
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Naoki Iwanaga
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shingo Kawano
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takuji Noro
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Michio Machida
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Ikuo Watanobe
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroyuki Sugo
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
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Sim N, Lee H, Goyal N, Cramer JD. Surgical site antiseptic preparations for otolaryngology - Head and neck surgery: A current review. Am J Otolaryngol 2024; 45:104280. [PMID: 38615452 DOI: 10.1016/j.amjoto.2024.104280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To review current literature and guidelines on antiseptic surgical site preparations for preventing surgical site infections with consideration of contraindications specific to head and neck surgery. DATA SOURCES PubMed/MEDLINE, clinicaltrials.gov, accessdata.fda.gov, Manufacturer websites. REVIEW METHODS A scoping review on the literature and clinical studies comparing the efficacy of different surgical site preparations. Studies were included if they were a randomized controlled trial (RCT) comparing at least two commonly used and available antiseptic preparations. Additionally, a compilation of warnings and contraindications from manufacturer labels and articles are included. Due to the lack of randomized controlled trials concerning antiseptic preparation use in head and neck surgery specifically, an additional search was executed for articles not limited to randomized controlled trials that compared different antiseptic preparation used in surgeries concerning the head and neck. RESULTS Of 56,983 resulting abstracts and 3798 of them being screened, 25 RCTs were included. These RCTs included a variety of surgeries including gastrointestinal, obstetric, gynecologic, orthopedic, and vascular procedures. When searching for abstracts concerning head and neck surgeries, 9 studies were found and included. CONCLUSIONS To reduce surgical site infections and avoid application in situations with contraindications, practicing surgeons need to be familiar with the existing literature regarding different surgical preparations and what warnings manufacturers have listed on the products. Optimal surgical site preparation for head and neck surgery is challenging as proximity to oxygen contraindicates newer alcohol-based options that are potentially flammable. We summarize evidence-based surgical site preparation for head and neck surgery.
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Affiliation(s)
- Nathan Sim
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Hannah Lee
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Neerav Goyal
- Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, United States
| | - John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, United States.
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Iida H, Maehira H, Kaida S, Takebayashi K, Miyake T, Tani M. Randomized controlled trial of olanexidine gluconate and povidone iodine for surgical site infection after gastrointestinal surgery. Ann Gastroenterol Surg 2024; 8:332-341. [PMID: 38455490 PMCID: PMC10914690 DOI: 10.1002/ags3.12739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 03/09/2024] Open
Abstract
Aim Antiseptics used at surgical sites are vital to preventing surgical site infections (SSI). In this study, a comparative investigation of the novel antiseptics olanexidine gluconate (OG) and povidone-iodine (PI) was conducted to determine whether OG is more effective than PI against SSI after gastrointestinal surgery. Methods This prospective, randomized, single-blind, interventional, single-center study was conducted between August 2018 and February 2021. Patients scheduled for large-scale gastrointestinal surgeries were randomized into two groups and administered OG (OG group) or PI (PI group) as preoperative antiseptics. The primary endpoint was the SSI occurrence rate within 30 days after surgery. Results In total, 525 patients were enrolled in this study, of whom 256 and 254 were in the OG and PI groups, respectively. The total SSI occurrence rate in the OG group (10.8%; n = 26) and the PI group (13.0%; n = 33) was not significantly different (p = 0.335). The occurrence rate of superficial incisional SSI and organ/space SSI did not significantly differ between the groups; however, that of deep incisional SSI showed a significant difference, with 0.4% (n = 1) in the OG group and 4.3% (n = 11) in the PI group (p = 0.003). Conclusion OG, as a preoperative skin antiseptic, did not reduce the occurrence rate of total SSI. However, deep incisional SSI may be reduced using OG.
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Affiliation(s)
- Hiroya Iida
- Department of SurgeryShiga University of Medical ScienceOtsuJapan
| | | | - Sachiko Kaida
- Department of SurgeryShiga University of Medical ScienceOtsuJapan
| | | | - Toru Miyake
- Department of SurgeryShiga University of Medical ScienceOtsuJapan
| | - Masaji Tani
- Department of SurgeryShiga University of Medical ScienceOtsuJapan
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Fakoya A, Afolabi A, Ayandipo O, Makanjuola O, Adepoju O, Ajagbe O, Afuwape OO. A Comparison of Chlorhexidine-Alcohol and Povidone-Iodine-Alcohol on the Incidence of Surgical Site Infection. Cureus 2024; 16:e51901. [PMID: 38333453 PMCID: PMC10849996 DOI: 10.7759/cureus.51901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Surgical site infection (SSI) persists as a global challenge, accounting for 20%-25% of all healthcare-associated infections. The SSI rate has been reported to range from 2.5% to 41.9%. Skin preparation with acceptable antiseptic preparations has a high recommendation from the Centers for Disease Control as an SSI preventive measure. AIM The aim was to compare the efficacy of 10% povidone-iodine in 70% isopropyl alcohol with 2% chlorhexidine in 70% isopropyl alcohol in preventing SSI. METHOD This prospective randomized study included patients who were followed up for 30 days looking for SSI. Swabs were taken from wounds that developed SSI. A culture of all swabs was done. RESULT One hundred and fifty-three patients were recruited into the study. Overall, eight (5.23%) of the 153 patients developed SSI. The SSI rate in clean wounds was 2.6%, while the SSI rate in clean-contaminated wounds was 7.9%. No statistically significant difference was found (p=0.141) between the two groups.
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Affiliation(s)
| | | | | | | | | | | | - Oludolapo O Afuwape
- Surgery/General Surgery, University College Hospital, University of Ibadan, Ibadan, NGA
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Bai D, Zhou F, Wu L. Comparing the efficacy of chlorhexidine and povidone-iodine in preventing surgical site infections: A systematic review and meta-analysis. Int Wound J 2023; 21:e14463. [PMID: 37885342 PMCID: PMC10828524 DOI: 10.1111/iwj.14463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
Surgical site infections (SSIs) post-surgery impact patient health and raise healthcare costs. This meta-analysis examines the efficacy of antiseptics, chlorhexidine and povidone-iodine, in reducing SSIs, including various types, to settle ongoing debates on their comparative effectiveness. A systematic literature search conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was executed on four established databases without temporal restrictions. Only randomized controlled trials (RCTs) including patients aged 18 years or older undergoing clean or potentially contaminated surgeries were included. Two independent evaluators carried out study selection, data extraction and quality assessment, adhering to Cochrane Collaboration's risk of bias tool. Statistical analyses were performed using chi-square tests and the I2 index to evaluate heterogeneity, and meta-analyses were conducted employing either fixed-effects or random-effects models as warranted by the heterogeneity assessments. A total of 16 RCTs were included after rigorous selection from an initial pool of 1742 articles. The studies demonstrated low levels of heterogeneity, supporting the use of a fixed-effects model. Chlorhexidine exhibited statistically lower rates of overall SSIs (RR 0.75; 95% CI 0.64-0.88; p < 0.001), superficial SSIs (RR 0.62; 95% CI 0.47-0.82; p < 0.001) and deep SSIs compared to povidone-iodine. The study furnishes compelling evidence in favour of chlorhexidine as a more efficacious antiseptic agent over povidone-iodine in minimizing the risk of various types of SSIs.
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Affiliation(s)
- Dunyao Bai
- Department of PharmacyPuren Hospital Affiliated to Wuhan University of Science and TechnologyWuhanChina
| | - Fan Zhou
- Laboratory of Molecular MedicinePuren Hospital Affiliated to Wuhan University of Science and TechnologyWuhanChina
| | - Liuting Wu
- Department of PharmacyPuren Hospital Affiliated to Wuhan University of Science and TechnologyWuhanChina
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Wang P, Wang D, Zhang L. Effectiveness of chlorhexidine versus povidone-iodine for preventing surgical site wound infection: A meta-analysis. Int Wound J 2023; 21:e14394. [PMID: 37752735 PMCID: PMC10828122 DOI: 10.1111/iwj.14394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
A systematic evaluation was conducted to assess the efficacy of two disinfectants, chlorhexidine and povidone-iodine, as primary components in preventing surgical site infection (SSI). A comprehensive computerised search was performed in the PubMed, EMBASE, Web of Science, Cochrane Library, CNKI and Wanfang databases for randomised controlled trials (RCTs) on chlorhexidine and povidone-iodine disinfection for the prevention of SSI from inception until July 2023. Two independent researchers completed literature screening, data extraction and quality assessment of the included studies. The meta-analysis was conducted using RevMan 5.4 software. Ultimately, 20 RCTs were included, which included 13 133 patients, with 6460 patients in the chlorhexidine group and 6673 patients in the povidone-iodine group. The meta-analysis results revealed that the incidence rate of surgical site wound infections [odds ratio (OR): 0.67, 95% confidence interval (CI): 0.58-0.78, p < 0.001)], superficial SSI rate (OR: 0.59, 95% CI: 0.46-0.75, p < 0.001) and deep SSI rate (OR: 0.49, 95% CI: 0.31-0.79, p = 0.003) were all lower in patients subjected to chlorhexidine disinfection compared to those patients receiving povidone-iodine disinfection. Existing evidence suggests that chlorhexidine is more effective than povidone-iodine at preventing SSI. However, owing to the potential quality limitations of the included studies, further validation through high-quality large-scale RCTs is warranted.
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Affiliation(s)
- Panfeng Wang
- Department of PharmacyTaizhou First People's HospitalTaizhouChina
| | - Dandan Wang
- Department of PharmacyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Lingqiao Zhang
- Department of PharmacyTaizhou First People's HospitalTaizhouChina
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Takeuchi M, Obara H, Furube T, Kawakubo H, Kitago M, Okabayashi K, Aoyama J, Amemiya R, Fujisaki H, Sano J, Goto R, Sato Y, Kitagawa Y. Effect of aqueous olanexidine versus alcohol-based chlorhexidine for surgical skin antisepsis on incidence of surgical site infections in gastrointestinal surgery: multicentre randomised controlled clinical trial (OEDO trial) protocol. BMJ Open 2023; 13:e074169. [PMID: 37604635 PMCID: PMC10445365 DOI: 10.1136/bmjopen-2023-074169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) are among the most common nosocomial infections in surgery patients. Two types of preparations, povidone-iodine and chlorhexidine-alcohol, are commonly used in preoperative antiseptic procedures worldwide. However, there are inconsistencies among international guideline recommendations concerning skin antiseptics. This trial aimed to evaluate the superiority of olanexidine, which reduced SSI rates more than povidone-iodine in our previous randomised trial, over chlorhexidine-alcohol in clean-contaminated surgery. METHODS AND ANALYSIS This multicentre randomised controlled clinical trial will compare two antiseptics (1.5% olanexidine and 1.0% chlorhexidine-alcohol) to prevent SSI in clean-contaminated gastrointestinal surgeries with surgical wounds. On providing consent, patients aged <18 years will be included. The primary outcome will be the postoperative 30-day overall SSI rate, while the secondary outcomes will be the postoperative 30-day superficial incisional SSI rate, deep incisional SSI rate, organ/space SSI rate, positive bacterial wound culture rate, cultured bacterial strains, rates of intervention-related toxicity and allergic events (eg, erythema, pruritus, dermatitis and other symptoms of allergy around the region disinfected by the antiseptic during surgery), rate of reoperations due to SSI, medical economic effect indicators (based on health insurance claims) and hospital duration. The Mantel-Haenszel method will be used to estimate the adjusted risk ratio and its 95% CI for the primary analysis, which will compare the treatment effects. ETHICS AND DISSEMINATION The protocol was approved by the Institutional Review Board of Keio University School of Medicine and subsequently by the board of each participating site. Participant recruitment began in January 2023. The final results will be published in medical journals after international peer review. TRIAL REGISTRATION NUMBER UMIN000049712.
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Affiliation(s)
- Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tasuku Furube
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Junya Aoyama
- Department of Gastrointestinal Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Ryusuke Amemiya
- Department of Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Hiroto Fujisaki
- Department of Surgery, Hiratsuka City Hospital, Kanagawa, Japan
| | - Junichi Sano
- Department of Gastrointestinal Surgery, Saitama City Hospital, Saitama, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Wang Q, Cao M, Tao H, Fei Z, Huang X, Liang P, Liu B, Liu J, Lu X, Ma P, Si S, Wang S, Zhang Y, Zheng Y, Zang L, Chen X, Dong Z, Ge W, Guo W, Hu X, Huang X, Li L, Liang J, Liu B, Liu D, Liu L, Liu S, Liu X, Miao L, Ren H, Shi G, Shi L, Sun S, Tao X, Tong R, Wang C, Wang B, Wang J, Wang J, Wang X, Wang X, Xie J, Xie S, Yang H, Yang J, You C, Zhang H, Zhang Y, Zhao C, Zhao Q, Zhu J, Ji B, Guo R, Hang C, Xi X, Li S, Gong Z, Zhou J, Wang R, Zhao Z. Evidence-based guideline for the prevention and management of perioperative infection. J Evid Based Med 2023; 16:50-67. [PMID: 36852502 DOI: 10.1111/jebm.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND We have updated the guideline for preventing and managing perioperative infection in China, given the global issues with antimicrobial resistance and the need to optimize antimicrobial usage and improve hospital infection control levels. METHODS We conducted a comprehensive evaluation of the evidence for prevention and management of perioperative infection, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Revisions were made to the guidelines in response to feedback from the experts. RESULTS There were 17 questions prepared, for which 37 recommendations were made. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the meta-analysis results, recommendations were graded using the Delphi method to generate useful information. CONCLUSIONS This guideline provides evidence to perioperative antimicrobial prophylaxis that increased the rational use of prophylactic antimicrobial use, with substantial improvement in the risk-benefit trade-off.
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Affiliation(s)
- Qiaoyu Wang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Mingnan Cao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Hua Tao
- Department of Pharmacy, Beijing United Family Hospital, Beijing, P. R. China
| | - Zhimin Fei
- Department of Neurosurgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Xiufeng Huang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Pixia Liang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Jianping Liu
- Centre for Evidence-Based Medicine, Beijing University of Chinese Medicine, Beijing, P. R. China
| | - Xiaoyang Lu
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China
| | - Penglin Ma
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, P. R. China
| | - Shuyi Si
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yuewei Zhang
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yingli Zheng
- Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Lei Zang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiao Chen
- Department of Pharmacy, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P. R. China
| | - Zhanjun Dong
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, P. R. China
| | - Weihong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Wei Guo
- Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Xin Hu
- Department of Pharmacy, Beijing Hospital, Beijing, P. R. China
| | - Xin Huang
- Department of Pharmacy, The First Affiliated Hospital of Shandong First Medical University/Shandong Province Qianfoshan Hospital, Jinan, P. R. China
| | - Ling Li
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Jianshu Liang
- Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Baoge Liu
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Dong Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, HUST, Wuhan, P. R. China
| | - Linna Liu
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi'an, P. R. China
| | - Songqing Liu
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Xianghong Liu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, P. R. China
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Haixia Ren
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin, P. R. China
| | - Guangzhi Shi
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Luwen Shi
- Department of Pharmaceutical Administration, School of Pharmaceutical Sciences, Peking University, Beijing, P. R. China
| | - Shumei Sun
- Department of Pediatrics, Nanfang Hospital of Southern Medical University, Guangzhou, P. R. China
| | - Xia Tao
- Department of Pharmacy, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, P. R. China
| | - Cheng Wang
- Department of Pharmacy, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, P. R. China
| | - Bin Wang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - Jincheng Wang
- Orthopaedic Medical Center, The 2nd Hospital of Jilin University, Changchun, P. R. China
| | - Jingwen Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Xiaoling Wang
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiaoyan Wang
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Shouxia Xie
- Department of Pharmacy, Shenzhen People's Hospital, Shenzhen, P. R. China
| | - Hua Yang
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Jianxin Yang
- Department of Intervention Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Chao You
- Department of Neurosurgery, West China Hospital Sichuan University, Chengdu, P. R. China
| | - Hongyi Zhang
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yi Zhang
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin, P. R. China
| | - Chengson Zhao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Jiangsu Suzhou, P. R. China
| | - Qingchun Zhao
- Department of Pharmacy, General Hospital of Northern Theater Command, Shenyang, P. R. China
| | - Jiangguo Zhu
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Bo Ji
- Clinical Pharmacy, General Hospital of Southern Theatre Command of PLA, Guangzhou, P. R. China
| | - Ruichen Guo
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, P. R. China
| | - Chunhua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Xiaowei Xi
- Department of Gynecological Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Sheyu Li
- Department of Endocrinology and Metabolism/China Evidence-based Medicine Center, West China Hospital Sichuan University, Chengdu, P. R. China
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Jianxin Zhou
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Rui Wang
- Department of Drug Clinical Trial, PLA General Hospital, Beijing, P. R. China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
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Slobogean GP, Sprague S, Wells JL, Bhandari M, Harris AD, Mullins CD, Thabane L, Wood A, Della Rocca GJ, Hebden JN, Jeray KJ, Marchand LS, O'Hara LM, Zura RD, Lee C, Patterson JT, Gardner MJ, Blasman J, Davies J, Liang S, Taljaard M, Devereaux PJ, Guyatt G, Heels-Ansdell D, Marvel D, Palmer JE, Friedrich J, O'Hara NN, Grissom F, Gitajn IL, Morshed S, O'Toole RV, Petrisor B, Mossuto F, Joshi MG, D'Alleyrand JCG, Fowler J, Rivera JC, Talbot M, Pogorzelski D, Dodds S, Li S, Del Fabbro G, Szasz OP, Bzovsky S, McKay P, Minea A, Murphy K, Howe AL, Demyanovich HK, Hoskins W, Medeiros M, Polk G, Kettering E, Mahal N, Eglseder A, Johnson A, Langhammer C, Lebrun C, Nascone J, Pensy R, Pollak A, Sciadini M, Degani Y, Phipps H, Hempen E, Johal H, Ristevski B, Williams D, Denkers M, Rajaratnam K, Al-Asiri J, Gallant JL, Pusztai K, MacRae S, Renaud S, Adams JD, Beckish ML, Bray CC, Brown TR, Cross AW, Dew T, Faucher GK, Gurich Jr RW, Lazarus DE, Millon SJ, Moody MC, Palmer MJ, Porter SE, Schaller TM, Sridhar MS, Sanders JL, Rudisill Jr LE, Garitty MJ, Poole AS, Sims ML, Walker CM, Carlisle R, Hofer EA, Huggins B, Hunter M, Marshall W, Ray SB, Smith C, Altman KM, Pichiotino ER, Quirion JC, Loeffler MF, Cole AA, Maltz EJ, Parker W, Ramsey TB, Burnikel A, Colello M, Stewart R, Wise J, Anderson M, Eskew J, Judkins B, Miller JM, Tanner SL, Snider RG, Townsend CE, Pham KH, Martin A, Robertson E, Bray E, Sykes JW, Yoder K, Conner K, Abbott H, Natoli RM, McKinley TO, Virkus WW, Sorkin AT, Szatkowski JP, Mullis BH, Jang Y, Lopas LA, Hill LC, Fentz CL, Diaz MM, Brown K, Garst KM, Denari EW, Osborn P, Pierrie SN, Kessler B, Herrera M, Miclau T, Marmor MT, Matityahu A, McClellan RT, Shearer D, Toogood P, Ding A, Murali J, El Naga A, Tangtiphaiboontana J, Belaye T, Berhaneselase E, Pokhvashchev D, Obremskey WT, Jahangir AA, Sethi M, Boyce R, Stinner DJ, Mitchell PP, Trochez K, Rodriguez E, Pritchett C, Hogan N, Fidel Moreno A, Hagen JE, Patrick M, Vlasak R, Krupko T, Talerico M, Horodyski M, Pazik M, Lossada-Soto E, Gary JL, Warner SJ, Munz JW, Choo AM, Achor TS, Routt ML“C, Kutzler M, Boutte S, Warth RJ, Prayson MJ, Venkatarayappa I, Horne B, Jerele J, Clark L, Boulton C, Lowe J, Ruth JT, Askam B, Seach A, Cruz A, Featherston B, Carlson R, Romero I, Zarif I, Dehghan N, McKee M, Jones CB, Sietsema DL, Williams A, Dykes T, Guerra-Farfan E, Tomas-Hernandez J, Teixidor-Serra J, Molero-Garcia V, Selga-Marsa J, Porcel-Vazquez JA, Andres-Peiro JV, Esteban-Feliu I, Vidal-Tarrason N, Serracanta J, Nuñez-Camarena J, del Mar Villar-Casares M, Mestre-Torres J, Lalueza-Broto P, Moreira-Borim F, Garcia-Sanchez Y, Marcano-Fernández F, Martínez-Carreres L, Martí-Garín D, Serrano-Sanz J, Sánchez-Fernández J, Sanz-Molero M, Carballo A, Pelfort X, Acerboni-Flores F, Alavedra-Massana A, Anglada-Torres N, Berenguer A, Cámara-Cabrera J, Caparros-García A, Fillat-Gomà F, Fuentes-López R, Garcia-Rodriguez R, Gimeno-Calavia N, Martínez-Álvarez M, Martínez-Grau P, Pellejero-García R, Ràfols-Perramon O, Peñalver JM, Salomó Domènech M, Soler-Cano A, Velasco-Barrera A, Yela-Verdú C, Bueno-Ruiz M, Sánchez-Palomino E, Andriola V, Molina-Corbacho M, Maldonado-Sotoca Y, Gasset-Teixidor A, Blasco-Moreu J, Fernández-Poch N, Rodoreda-Puigdemasa J, Verdaguer-Figuerola A, Cueva-Sevieri HE, Garcia-Gimenez S, Viskontas DG, Apostle KL, Boyer DS, Moola FO, Perey BH, Stone TB, Lemke HM, Spicer E, Payne K, Hymes RA, Schwartzbach CC, Schulman JE, Malekzadeh AS, Holzman MA, Gaski GE, Wills J, Pilson H, Carroll EA, Halvorson JJ, Babcock S, Goodman JB, Holden MB, Williams W, Hill T, Brotherton A, Romeo NM, Vallier HA, Vergon A, Higgins TF, Haller JM, Rothberg DL, Olsen ZM, McGowan AV, Hill S, Dauk MK, Bergin PF, Russell GV, Graves ML, Morellato J, McGee SL, Bhanat EL, Yener U, Khanna R, Nehete P, Potter D, VanDemark III R, Seabold K, Staudenmier N, Coe M, Dwyer K, Mullin DS, Chockbengboun TA, DePalo Sr. PA, Phelps K, Bosse M, Karunakar M, Kempton L, Sims S, Hsu J, Seymour R, Churchill C, Mayfield A, Sweeney J, Jaeblon T, Beer R, Bauer B, Meredith S, Talwar S, Domes CM, Gage MJ, Reilly RM, Paniagua A, Dupree J, Weaver MJ, von Keudell AG, Sagona AE, Mehta S, Donegan D, Horan A, Dooley M, Heng M, Harris MB, Lhowe DW, Esposito JG, Alnasser A, Shannon SF, Scott AN, Clinch B, Weber B, Beltran MJ, Archdeacon MT, Sagi HC, Wyrick JD, Le TT, Laughlin RT, Thomson CG, Hasselfeld K, Lin CA, Vrahas MS, Moon CN, Little MT, Marecek GS, Dubuclet DM, Scolaro JA, Learned JR, Lim PK, Demas S, Amirhekmat A, Dela Cruz YM. Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial. Lancet 2022; 400:1334-1344. [PMID: 36244384 DOI: 10.1016/s0140-6736(22)01652-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chlorhexidine skin antisepsis is frequently recommended for most surgical procedures; however, it is unclear if these recommendations should apply to surgery involving traumatic contaminated wounds where povidone-iodine has previously been preferred. We aimed to compare the effect of aqueous 10% povidone-iodine versus aqueous 4% chlorhexidine gluconate on the risk of surgical site infection in patients who required surgery for an open fracture. METHODS We conducted a multiple-period, cluster-randomised, crossover trial (Aqueous-PREP) at 14 hospitals in Canada, Spain, and the USA. Eligible patients were adults aged 18 years or older with an open extremity fracture treated with a surgical fixation implant. For inclusion, the open fracture required formal surgical debridement within 72 h of the injury. Participating sites were randomly assigned (1:1) to use either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate immediately before surgical incision; sites then alternated between the study interventions every 2 months. Participants, health-care providers, and study personnel were aware of the treatment assignment due to the colour of the solutions. The outcome adjudicators and data analysts were masked to treatment allocation. The primary outcome was surgical site infection, guided by the 2017 US Centers for Disease Control and Prevention National Healthcare Safety Network reporting criteria, which included superficial incisional infection within 30 days or deep incisional or organ space infection within 90 days of surgery. The primary analyses followed the intention-to-treat principle and included all participants in the groups to which they were randomly assigned. This study is registered with ClinicalTrials.gov, NCT03385304. FINDINGS Between April 8, 2018, and June 8, 2021, 3619 patients were assessed for eligibility and 1683 were enrolled and randomly assigned to povidone-iodine (n=847) or chlorhexidine gluconate (n=836). The trial's adjudication committee determined that 45 participants were ineligible, leaving 1638 participants in the primary analysis, with 828 in the povidone-iodine group and 810 in the chlorhexidine gluconate group (mean age 44·9 years [SD 18·0]; 629 [38%] were female and 1009 [62%] were male). Among 1571 participants in whom the primary outcome was known, a surgical site infection occurred in 59 (7%) of 787 participants in the povidone-iodine group and 58 (7%) of 784 in the chlorhexidine gluconate group (odds ratio 1·11, 95% CI 0·74 to 1·65; p=0·61; risk difference 0·6%, 95% CI -1·4 to 3·4). INTERPRETATION For patients who require surgical fixation of an open fracture, either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate can be selected for skin antisepsis on the basis of solution availability, patient contraindications, or product cost. These findings might also have implications for antisepsis of other traumatic wounds. FUNDING US Department of Defense, Canadian Institutes of Health Research, McMaster University Surgical Associates, PSI Foundation.
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Jalalzadeh H, Groenen H, Buis DR, Dreissen YE, Goosen JH, Ijpma FF, van der Laan MJ, Schaad RR, Segers P, van der Zwet WC, Griekspoor M, Harmsen WJ, Wolfhagen N, Boermeester MA. Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis. THE LANCET. MICROBE 2022; 3:e762-e771. [PMID: 35985350 DOI: 10.1016/s2666-5247(22)00187-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/24/2022] [Accepted: 06/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is the most common postoperative complication and substantially increases health-care costs. Published meta-analyses and international guidelines differ with regard to which preoperative skin antiseptic solution and concentration has the highest efficacy. We aimed to compare the efficacy of different skin preparation solutions and concentrations for the prevention of SSIs, and to provide an overview of current guidelines. METHODS This systematic review and network meta-analysis compared different preoperative skin antiseptics in the prevention of SSIs in adult patients undergoing surgery of any wound classification. We searched for randomised controlled trials (RCTs) in MEDLINE, Embase, and Cochrane CENTRAL, published up to Nov 23, 2021, that directly compared two or more antiseptic agents (ie, chlorhexidine, iodine, or olanexidine) or concentrations in aqueous and alcohol-based solutions. We excluded paediatric, animal, and non-randomised studies, and studies not providing standard preoperative intravenous antibiotic prophylaxis. Studies with no SSIs in both groups were excluded from the quantitative analysis. Two reviewers screened and reviewed eligible full texts and extracted data. The primary outcome was the occurrence of SSI (ie, superficial, deep, and organ space). We conducted a frequentist random effects network meta-analysis to estimate the network effects of the skin preparation solutions on the prevention of SSIs. A risk-of-bias and Grading of Recommendations, Assessment, Development, and Evaluation assessment were done to determine the certainty of the evidence. This study is registered with PROSPERO, CRD42021293554. FINDINGS Overall, 2326 articles were identified, 33 studies were eligible for the systematic review, and 27 studies with 17 735 patients reporting 2144 SSIs (overall incidence of 12·1%) were included in the quantitative analysis. Only 2·0-2·5% chlorhexidine in alcohol (relative risk 0·75, 95% CI 0·61-0·92) and 1·5% olanexidine (0·49, 0·26-0·92) significantly reduced the rate of SSIs compared with aqueous iodine. For clean surgery, we found no difference in efficacy between different concentrations of chlorhexidine in alcohol. Seven RCTs were at high risk of bias, 24 had some concerns, and two had low risk of bias. Heterogeneity across the studies was moderate (I2=27·5%), and netsplitting did not show inconsistencies between direct and indirect comparisons. Five of ten studies that mentioned adverse events related to the skin preparation solutions reported no adverse events, and five reported a total of 56 mild events (mainly erythema, pruritus, dermatitis, skin irritation, or mild allergic symptoms); none reported a substantial difference in adverse events between groups. INTERPRETATION For adult patients undergoing a surgical procedure of any wound classification, skin preparation using either 2·0-2·5% chlorhexidine in alcohol or 1·5% olanexidine is most effective in the prevention of SSIs. For clean surgery, no specific concentration of chlorhexidine in alcohol can be recommended. The efficacy of olanexidine was established by a single randomised trial and further investigation is needed. FUNDING Dutch Association for Quality Funds Medical Specialists.
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Affiliation(s)
- Hasti Jalalzadeh
- Amsterdam University Medical Center, Department of Surgery, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, Netherlands; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Hannah Groenen
- Amsterdam University Medical Center, Department of Surgery, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, Netherlands; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Dennis R Buis
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Yasmine Em Dreissen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Jon Hm Goosen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Frank Fa Ijpma
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Maarten J van der Laan
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Roald R Schaad
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Patrique Segers
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Wil C van der Zwet
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Mitchel Griekspoor
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Wouter J Harmsen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Niels Wolfhagen
- Amsterdam University Medical Center, Department of Surgery, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, Netherlands; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands
| | - Marja A Boermeester
- Amsterdam University Medical Center, Department of Surgery, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, Netherlands; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Utrecht, Netherlands.
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Hampton J, Park SSW, Palazzi K, Oldmeadow C, Carroll R, Attia J, Smith SR. The effect of preoperative skin preparation on clinical outcomes with incisional surgery: a network meta-analysis. ANZ J Surg 2022; 92:2859-2867. [PMID: 35698832 DOI: 10.1111/ans.17831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preoperative skin antiseptics are used prior to surgery to reduce the risk of surgical site infection (SSI). There is debate as to which is the most effective. The aim of this network meta-analysis (NMA) is to compare the effectiveness of different skin preparations at reducing SSIs in patients undergoing incisional surgery. METHODS The study protocol was published in PROSPERO (CRD4202181599) a priori with predefined search terms and inclusion/exclusion criteria. The skin preparations for comparison were: chlorhexidine/alcohol (CHA), chlorhexidine/water (CHW), poviodine/alcohol (PVIA), poviodine/water (PVIW). The records identified were screened by two authors independently by title, abstract and in full text. The revised tool for risk-of bias (ROB2) assessment was used. RESULTS Twenty-nine RCTs involving 15 796 patients were included in the NMA. A significant but small increase in the odds of infection was seen in the PVIW group compared to the CHA group (OR 1.34, 95%CrI 1.09-1.64), but other comparisons were not statistically significantly different. Ranking the treatment arms showed there was a 64% probability that CHA is the most effective and a 62.7% probability that PVIW is the least effective treatment. CONCLUSION Chlorhexidine/alcohol (CHA) was found to be the most effective for prevention of superficial and deep SSI while PVIW was the least. There was no differences seen between CHA and PVIA, or CHW and PVIW. The superiority of CHA is likely due to the effect of the alcohol in the base. Hence the choice between CHA and PVIA should be based on health and cost considerations.
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Affiliation(s)
- Jacob Hampton
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sean S W Park
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | | | - Rosemary Carroll
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Stephen R Smith
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Department of Surgery, Calvary Mater Hospital, Newcastle, New South Wales, Australia
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Kubo N, Furusawa N, Takeuchi D, Imai S, Masuo H, Umemura K, Terada M. Clinical study of a new skin antiseptic olanexidine gluconate in gastrointestinal cancer surgery. BMC Surg 2022; 22:194. [PMID: 35590405 PMCID: PMC9118739 DOI: 10.1186/s12893-022-01641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/10/2022] [Indexed: 11/20/2022] Open
Abstract
Background Surgical site infection (SSI) is a common complication of gastrointestinal surgery. Olanexidine gluconate (OLG) is a novel skin antiseptic that is effective against a wide range of bacteria. The purpose of this study was to evaluate the bactericidal efficacy of OLG in gastrointestinal cancer surgery. Methods This retrospective study included a total of 281 patients who underwent gastrointestinal cancer surgery (stomach or colon). The patients were divided into two groups: 223 patients were treated with OLG (OLG group), and 58 patients were treated with povidone-iodine (PVP-I) (control group). The efficacy and safety outcomes were measured as the rate of SSI within 30 days after surgery. In addition, we conducted subgroup analyses according to the surgical approach (open or laparoscopic) or primary lesion (stomach or colon). Results There was a significant difference in the rate of SSI between the control group and OLG group (10.3% vs. 2.7%; p = 0.02). There was a significant difference in the SSI rate in terms of superficial infection (8.6% vs. 2.2%; p = 0.0345) but not in deep infection (1.7% vs. 0.5%; p = 0.371). There was no significant difference between the control group and OLG group in the overall rate of adverse skin reactions (5.2% vs. 1.8%; p = 0.157). Conclusion This retrospective study demonstrates that OLG is more effective than PVP-I in preventing SSI during gastrointestinal cancer surgery.
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Affiliation(s)
- Naoki Kubo
- Department of Surgery, Nagano Prefectural Shinshu Medical Center, 1337, Suzaka, Nagano, 382-0091, Japan.
| | - Norihiko Furusawa
- Department of Surgery, Nagano Prefectural Shinshu Medical Center, 1337, Suzaka, Nagano, 382-0091, Japan
| | - Daisuke Takeuchi
- Department of Surgery, Nagano Prefectural Shinshu Medical Center, 1337, Suzaka, Nagano, 382-0091, Japan
| | - Shinichiro Imai
- Department of Surgery, Nagano Prefectural Shinshu Medical Center, 1337, Suzaka, Nagano, 382-0091, Japan
| | - Hitoshi Masuo
- Department of Surgery, Nagano Prefectural Shinshu Medical Center, 1337, Suzaka, Nagano, 382-0091, Japan
| | - Kentaro Umemura
- Department of Surgery, Nagano Prefectural Shinshu Medical Center, 1337, Suzaka, Nagano, 382-0091, Japan
| | - Masaru Terada
- Department of Surgery, Nagano Prefectural Shinshu Medical Center, 1337, Suzaka, Nagano, 382-0091, Japan
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Cole WW, Familia M, Miskimin C, Mulcahey MK. Preoperative Optimization and Tips to Avoiding Surgical Complications Before the Incision. Sports Med Arthrosc Rev 2022; 30:2-9. [PMID: 35113836 DOI: 10.1097/jsa.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In preparation for surgery, it is important for surgeons to have a detailed discussion with patients about the risks, benefits, and alternatives to surgery. Patient optimization, ensuring the patient is in the best medical condition before surgery, is also an important aspect of patient care that the surgeon must consider. Although complications cannot be eliminated, there are often opportunities to optimize patients, so these risks can be minimized based on current evidence-based medicine. To minimize the risk of complications, the surgeon should take an active role in each step of the patient's care beginning with the history and physical examination, obtaining the correct preoperative labs, and continuing through positioning, draping, and prepping before making an incision.
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Affiliation(s)
- Wendell W Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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Bouza E, de Alarcón A, Fariñas MC, Gálvez J, Goenaga MÁ, Gutiérrez-Díez F, Hortal J, Lasso J, Mestres CA, Miró JM, Navas E, Nieto M, Parra A, Pérez de la Sota E, Rodríguez-Abella H, Rodríguez-Créixems M, Rodríguez-Roda J, Sánchez Espín G, Sousa D, Velasco García de Sierra C, Muñoz P, Kestler M. Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections ( SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery ( SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases ( CIBERES). J Clin Med 2021; 10:5566. [PMID: 34884268 PMCID: PMC8658224 DOI: 10.3390/jcm10235566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023] Open
Abstract
This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.
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Affiliation(s)
- Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | | | - Juan Gálvez
- Virgen Macarena University Hospital, 41009 Seville, Spain;
| | | | - Francisco Gutiérrez-Díez
- Cardiovascular Surgery Department, Marques de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | - Javier Hortal
- Anesthesia and Intensive Care Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - José Lasso
- Plastic Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Carlos A. Mestres
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - José M. Miró
- Infectious Diseases Services, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Enrique Navas
- Infectious Diseases Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
| | - Mercedes Nieto
- Cardiovascular Unit, Intensive Care Department, San Carlos Clinical Hospital, 28040 Madrid, Spain;
| | - Antonio Parra
- Department of Radiology, Marquez de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | | | - Hugo Rodríguez-Abella
- Cardiac Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Marta Rodríguez-Créixems
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | - Gemma Sánchez Espín
- Heart Clinical Management Unit, Virgen de la Victoria University Hospital, 29006 Malaga, Spain;
| | - Dolores Sousa
- Infectious Diseases Department, A Coruña Hospital Complex, 15006 A Coruña, Spain;
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | - Martha Kestler
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
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Dorestan N, Ostadian N, Mahmoudinezhad SS, Farajzadeh Sheikh A, Moradi K. Comparative efficacy of 0.2% chlorhexidine and 10% Betadine for perioral skin disinfection prior to oral surgical procedures: a clinical trial. Ir J Med Sci 2021; 191:2207-2211. [PMID: 34767148 DOI: 10.1007/s11845-021-02850-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is a possible postoperative complication. Preoperative application of antiseptics on the surgical site can decrease the rate of SSIs. AIM This study aimed to compare the efficacy of 0.2% chlorhexidine (CHX) and 10% Betadine (povidone-iodine) for perioral skin disinfection prior to oral surgical procedures. METHODS This clinical trial (IRCT20181017041365N1) (registration date: 2019/05/04) evaluated 57 male patients who were randomly selected among those presenting to the Periodontology Department of Ahvaz Jundishapur University. Baseline microbial samples were collected from the perioral skin at the right and left sides of the face in each patient by sterile swabs. Next, the perioral area was disinfected with 10% Betadine in the right side and 0.2% CHX in the left side. Secondary microbial samples were then collected. Wilcoxon matched-pairs signed-ranks and Mann-Whitney test were used to compare the colony counts. The significance level was set at p ≤ 0.05. Data were analyzed with the Stata program, version15.1. RESULTS The bacterial colony count was 3147 (314,700) in the Betadine and 3139 (313,900) in the CHX group at baseline (P = 0.86). These values changed to 1196 (119,600) in the Betadine (P < 0.001) and 857 (85,700) in the CHX (P < 0.001) group after disinfection. A significant difference was found in colony count between the CHX and Betadine groups after intervention (P = 0.0001). CONCLUSION According to the results, 0.2% CHX has higher antimicrobial efficacy than 10% Betadine for perioral disinfection prior to oral surgical procedures. TRIAL REGISTRATION IRCT20181017041365N1. Registered on 2019/05/04.
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Affiliation(s)
- Navid Dorestan
- Department of Periodontology, School of Dental Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Negin Ostadian
- Department of Periodontology, School of Dental Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sadaf Sadat Mahmoudinezhad
- Department of Periodontology, School of Dental Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Farajzadeh Sheikh
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kooshan Moradi
- Department of Periodontology, School of Dental Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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de Andrade GV, de Souza NMG, Rocha ACF, Ribeiro SB, da Silva VM, Oliveira LAF. Surgical site infection prevention bundle for children submitted to cardiac surgery. Rev Esc Enferm USP 2021; 55:e20200470. [PMID: 34435612 DOI: 10.1590/1980-220x-reeusp-2020-0470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To build and validate the content and appearance of a surgical site infection prevention bundle for children submitted to cardiac surgery. METHOD Methodological study in two phases: 1) Bundle construction from an integrative literature review from which interventions have been extracted to compose the instrument; 2) Bundle content and appearance validation by 24 judges. RESULTS The 24 found articles presented 17 interventions for surgical site infection prevention in this population. Out of them, seven intervention proposals have been chosen to compose the bundle and sent for assessment by judges. The final proposal includes all the seven items chosen in the construction phase and has achieved a content validity index over 0.8 in all items referring to content and appearance. CONCLUSION The content and appearance of the developed bundle proposes care for the prevention of surgical site infection throughout the perioperative period.
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Li L, Wang Y, Wang S. Efficacy comparison of chlorhexidine and iodine preparation in reduction of surgical site infection: A systemic review and meta-analysis. Int J Nurs Stud 2021; 127:104059. [PMID: 35121520 DOI: 10.1016/j.ijnurstu.2021.104059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chlorhexidine and povidone-iodine are the most common disinfectants used in preoperative skin preparation. However, there is no consistent conclusion regarding the prevention of surgical site infection (SSI) and bacterial culture data. OBJECTIVE To assess the efficacy of chlorhexidine and povidone-iodine in the prevention of postoperative SSI and relevant bacterial data. DESIGN Systematic Review and Meta-Analysis SETTINGS: N/A PARTICIPANTS: N/A METHOD: Literature relevant to "skin antisepsis" and "surgical site infections" was retrieved from PUBMED, Web of Science, EMBASE, CINHAL and CNKI. The incidence of SSI was the primary outcome, while the secondary outcome was bacterial data from the infected incision. All data were analyzed with Revman 5.3 and Stata Statistical Software. RESULTS A total of 36 studies were identified in this study, which included 16,872 participants. This study revealed that chlorhexidine is superior to povidone-iodine in the prevention of postoperative SSI (risk ratio [RR], 0.73; 95% confidence interval [CI], 0.61-0.87; p = 0.019, I2 = 39%). Further meta-regression analysis revealed that the effect of chlorhexidine was directly associated with the type of incision, but failed to differentiate between the subgroups divided according to the type of incision. With respect to bacteria colonization, the most common bacteria for chlorhexidine arm were propionibacterium's, while the most common bacteria for the iodine arm were staphylococci species. CONCLUSION In comparison to povidone-iodine, chlorhexidine showed better results in preventing postoperative SSI.
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Affiliation(s)
- Li Li
- Clean Operating department, Harbin Medical University Cancer Hospital, Harbin City, Heilongjiang Province, China
| | - Yu Wang
- The Image Center, Harbin Medical University Cancer Hospital, Harbin City, Heilongjiang Province, China.
| | - Shouyan Wang
- Clean Operating department, Harbin Medical University Cancer Hospital, Harbin City, Heilongjiang Province, China
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Obara H, Takeuchi M, Kawakubo H, Shinoda M, Okabayashi K, Hayashi K, Sekimoto Y, Maeda Y, Kondo T, Sato Y, Kitagawa Y. Aqueous olanexidine versus aqueous povidone-iodine for surgical skin antisepsis on the incidence of surgical site infections after clean-contaminated surgery: a multicentre, prospective, blinded-endpoint, randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2020; 20:1281-1289. [PMID: 32553191 DOI: 10.1016/s1473-3099(20)30225-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/08/2020] [Accepted: 03/13/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is the most common problem after surgery. Although several guidelines have indicated the efficacy of antiseptics, such as chlorhexidine-alcohol and povidone-iodine, in reducing SSI rate, the optimal recommendation is still not established. Olanexidine might have higher bactericidal activity than other antiseptic agents. However, no randomised study has evaluated the efficacy and safety of olanexidine over conventional antiseptics. We compared the effect of aqueous olanexidine and aqueous povidone-iodine on the incidence of SSI following clean-contaminated surgery. METHODS This was a multicentre, prospective, randomised, blinded-endpoint superiority trial for surgical skin antisepsis in clean-contaminated gastrointestinal and hepatobiliary pancreatic surgeries in four Japanese hospitals. Patients aged 20 years or older who underwent elective clean-contaminated wound surgery were randomly assigned in a 1:1 replacement ratio using a computer-generated block randomisation. Patients were randomly assigned to surgical skin antisepsis with an aqueous formulation of 1·5% olanexidine or surgical skin antisepsis with an aqueous formulation of 10% povidone-iodine before surgery. We used olanexidine in a ready-to-use applicator, and povidone-iodine was administered by a brush or by compression using pliers. Both antiseptics were applied from the papilla with a cranial limit and to the upper thigh with a caudal limit. The antiseptics were allowed to dry for 3 min, and then surgery started. Participants, some investigators, and data analysts were masked to treatment allocation. Participant enrolment was done by non-masked investigators. The primary outcome was 30-day SSI assessed in the intention-to-treat population. The surgical wound site of each participant was observed daily. After discharge, participants underwent at least one outpatient visit within 30 days after surgery. This trial is registered with University hospital Medical Information Network, 000031560. FINDINGS Between June 10, 2018, and April 18, 2019, 883 patients were assessed for eligibility. 587 patients were eligible and 294 received olanexidine and 293 received aqueous povidone-iodine before surgery. 30-day SSI occurred in 19 (7%) patients in the olanexidine group and 39 patients (13%) patients in the povidone-iodine group (adjusted risk difference -0·069; 90% CI -0·109 to -0·029; adjusted risk ratio [RR] 0·48, 90% CI 0·30 to 0·74; p=0·002). Five patients (2%) in the olanexidine group and five (2%) in the povidone-iodine group developed adverse skin reactions (adjusted RR 0·99, 95% CI 0·29 to 3·40; p=1·00). INTERPRETATION Olanexidine significantly reduced the occurrence of overall SSI and superficial incisional SSI compared with aqueous povidone-iodine in clean-contaminated surgery. Our results indicate that olanexidine might have a role to prevent SSI in patients who undergo clean-contaminated surgeries. FUNDING Keio University and Ohyama Health Foundation.
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Affiliation(s)
- Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koki Hayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasuhito Sekimoto
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yusuke Maeda
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Takayuki Kondo
- Department of Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Nakamura K, Sho M, Kinoshita S, Akahori T, Nagai M, Nakagawa K, Takagi T, Ikeda N. New insight into the association between bile infection and clinically relevant pancreatic fistula in patients undergoing pancreatoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:992-1001. [PMID: 32506812 DOI: 10.1002/jhbp.781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/30/2020] [Accepted: 05/21/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The association between bacterial infection and clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD) has not been fully elucidated. METHODS Microbiological data for intraoperative bile culture (BC) and drain culture on postoperative day 4 (DC) were collected. The study population was classified into the following three groups: P1 (positive BC and DC), P2 (positive BC and negative DC), and N (negative BC). A total of 209 patients (P1: 38, P2: 72, and N: 99) who underwent PD between May 2013 and May 2018 met the inclusion criteria of the study. RESULTS The rate of CR-POPF was significantly higher in the P1 group (34.2%) than in the P2 (12.5%; P = .007) and N groups (14.1%; P = .008). Between P1 and P2 groups, a significant difference was observed in the proportion of Enterococcus faecalis grown in BC (42.1% vs 4.2%; P < .001). Multivariable logistic regression analysis showed that the presence of E faecalis in bile was independently associated with CR-POPF. CONCLUSIONS The detection of both bile and postoperative abdominal fluid infections can be more accurate in predicting CR-POPF. Furthermore, the presence of E faecalis in bile may serve as a novel surrogate marker for CR-POPF.
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Affiliation(s)
- Kota Nakamura
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | | | - Takahiro Akahori
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Kenji Nakagawa
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Tadataka Takagi
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Naoya Ikeda
- Department of Surgery, Nara Medical University, Kashihara, Japan
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Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg 2020; 44:2056-2084. [DOI: 10.1007/s00268-020-05462-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Boisson M, Corbi P, Kerforne T, Camilleri L, Debauchez M, Demondion P, Eljezi V, Flecher E, Lepelletier D, Leprince P, Nesseler N, Nizou JY, Roussel JC, Rozec B, Ruckly S, Lucet JC, Timsit JF, Mimoz O. Multicentre, open-label, randomised, controlled clinical trial comparing 2% chlorhexidine-70% isopropanol and 5% povidone iodine-69% ethanol for skin antisepsis in reducing surgical-site infection after cardiac surgery: the CLEAN 2 study protocol. BMJ Open 2019; 9:e026929. [PMID: 31213447 PMCID: PMC6596966 DOI: 10.1136/bmjopen-2018-026929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/14/2019] [Accepted: 04/12/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Surgical-site infection (SSI) is the second most frequent cause of healthcare-associated infection worldwide and is associated with increased morbidity, mortality and healthcare costs. Cardiac surgery is clean surgery with low incidence of SSI, ranging from 2% to 5%, but with potentially severe consequences.Perioperative skin antisepsis with an alcohol-based antiseptic solution is recommended to prevent SSI, but the superiority of chlorhexidine (CHG)-alcohol over povidone iodine (PVI)-alcohol, the two most common alcohol-based antiseptic solutions used worldwide, is controversial. We aim to evaluate whether 2% CHG-70% isopropanol is more effective than 5% PVI-69% ethanol in reducing the incidence of reoperation after cardiac surgery. METHODS AND ANALYSIS The CLEAN 2 study is a multicentre, open-label, randomised, controlled clinical trial of 4100 patients undergoing cardiac surgery. Patients will be randomised in 1:1 ratio to receive either 2% CHG-70% isopropanol or 5% PVI-69% ethanol for perioperative skin preparation. The primary endpoint is the proportion of patients undergoing any re-sternotomy between day 0 and day 90 after initial surgery and/or any reoperation on saphenous vein/radial artery surgical site between day 0 and day 30 after initial surgery. Data will be analysed on the intention-to-treat principle. ETHICS AND DISSEMINATION This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2017-005169-33 and NCT03560193.
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Affiliation(s)
- Matthieu Boisson
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- INSERM U1070, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
| | - Pierre Corbi
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Thomas Kerforne
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Camilleri
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Mathieu Debauchez
- Cardiothoracic Surgery Unit, Institut Mutualiste Montsouris, Paris, France
| | - Pierre Demondion
- Cardiothoracic Surgery Unit, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Vedat Eljezi
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Erwan Flecher
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Didier Lepelletier
- Infection Control Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pascal Leprince
- Cardiothoracic Surgery Unit, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Nicolas Nesseler
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | - Bertrand Rozec
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphane Ruckly
- INSERM UMR 1137, Universite Paris Diderot UFR de Medecine Site Xavier-Bichat, Paris, France
| | - Jean-Christophe Lucet
- Infection Control Unit, Hopital Bichat - Claude-Bernard, Paris, France
- Iame, INSERM, Paris, France
| | - Jean-François Timsit
- INSERM UMR 1137, Universite Paris Diderot UFR de Medecine Site Xavier-Bichat, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, Hopital Bichat - Claude-Bernard, Paris, France
| | - Olivier Mimoz
- INSERM U1070, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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Takeuchi M, Obara H, Kawakubo H, Shinoda M, Okabayashi K, Mayanagi S, Irino T, Fukuda K, Nakamura R, Wada N, Kitago M, Yagi H, Abe Y, Oshima G, Hori S, Tsuruta M, Ishida T, Yokose T, Hirukawa K, Isobe Y, Sekimoto Y, Harada H, Maeda Y, Shito M, Kondo T, Sato Y, Kitagawa Y. Comparison of olanexidine versus povidone-iodine for preventing surgical site infection in gastrointestinal surgery: study protocol for a multicentre, single-blind, randomised controlled clinical trial. BMJ Open 2019; 9:e028269. [PMID: 31142533 PMCID: PMC6549615 DOI: 10.1136/bmjopen-2018-028269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The prevalence of surgical site infection (SSI) remains higher in gastrointestinal surgery than in other surgeries. Although several guidelines have indicated the efficacy of chlorhexidine and povidone-iodine in reducing the SSI rate, the optimal recommendation has still not been established. Therefore, it is necessary to determine the more effective antiseptic for surgical site preparation. Olanexidine (1.5% olanedine, Otsuka Pharmaceutical Factory, Tokushima, Japan), which is a new antiseptic in Japan, has antimicrobial activity against a wide range of bacteria, including Gram-positive and Gram-negative bacteria. Our study will contribute to determining a new antiseptic for use in gastrointestinal and other surgeries. METHODS AND ANALYSIS We propose a multicentre, randomised controlled clinical trial for comparing two treatments, that is, 1.5% olanexidine or 10% povidone-iodine, for surgical skin preparation to prevent SSI in clean-contaminated gastrointestinal surgeries with surgical wounds. Patients aged ≥20 years at the time of consent will be included. The primary outcome measure is the 30-day postoperative SSI rate. For the primary analysis, which is aimed at comparing the treatment effects, the adjusted risk ratio and its 95% CI will be estimated using the Mantel-Haenszel method. ETHICS AND DISSEMINATION The protocol was first approved by the Institutional Review Board of Keio University School of Medicine, followed by the institutional review board of each participating site. Participant recruitment began in June 2018. The final results will be published in international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER UMIN 000031560; Pre-results.
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Affiliation(s)
- Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Mayanagi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Go Oshima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Ishida
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Yokose
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuya Hirukawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoh Isobe
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yasuhito Sekimoto
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hirohisa Harada
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yusuke Maeda
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Masaya Shito
- Department of Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Takayuki Kondo
- Department of Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Maurer E, Reuss A, Maschuw K, Aminossadati B, Neubert T, Schade-Brittinger C, K. Bartsch D. Superficial Surgical Site Infection Following the Use of Intracutaneous Sutures Versus Staples. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:365-371. [PMID: 31315799 PMCID: PMC6647811 DOI: 10.3238/arztebl.2019.0365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/03/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Superficial wound infections after gastrointestinal surgery markedly impair the affected patients' quality of life. As it is still unknown which method of skin closure is best for the reduction of wound infections in elective gastrointestinal sur- gery, we compared the frequency of wound infections after intracutaneous suturing versus skin stapling. METHODS In a prospective, randomized, single-center study, patients undergoing elective gastrointestinal surgery were intraoperatively randomized to skin closure either with an intracutaneous suture or with staples. The primary endpoint-the occurrence of a grade A1 wound infection within 30 days of surgery-was evaluated according to the intention-to-treat principle. RESULTS Out of a total of 280 patients, 141 were randomized to intracutaneous suturing and 139 to stapling. The groups did not differ significantly with respect to age, sex, or ASA classification. 19 of the 141 patients in the intracutaneous suturing group (13.5%) had a grade A1 wound infection, compared with 23 of 139 in the stapling group (16.6%) (odds ratio [OR]: 0.79; 95% confidence interval: [0.41; 1.52]; p = 0.47). A multiple regression analysis revealed that the type of surgery (colorectal vs. other), the approach, and the incision length were independent risk factors for a grade A1 wound infection. When wound dehiscences were additionally considered, wound complications were found to have arisen significantly more often in the stapling group than in the intracutaneous suturing group (16.3% [23/141] versus 30.2% [42/139], OR: 0.45 [0.25; 0.80]; p = 0.006). CONCLUSION In elective gastrointestinal surgery, intracutaneous suturing was not found to be associated with a lower rate of superficial wound infections than skin stapling, but fewer wound dehiscences occurred in the intracutaneous suturing group.
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Affiliation(s)
- Elisabeth Maurer
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | - Alexander Reuss
- Clinica Trials Coordination Center (KKS), Philipps-Universität Marburg, Marburg
| | - Katja Maschuw
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | - Behnaz Aminossadati
- Clinica Trials Coordination Center (KKS), Philipps-Universität Marburg, Marburg
| | - Thomas Neubert
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
| | | | - Detlef K. Bartsch
- Department of Visceral, Thoracic and Vascular Surgery Universität Gießen und Marburg GmbH, Marburg
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Clinical Trials and Their Principles in Urologic Oncology. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kick BL, Gumber S, Wang H, Moore RH, Taylor DK. Evaluation of 4 Presurgical Skin Preparation Methods in Mice. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2019; 58:71-77. [PMID: 30609948 PMCID: PMC6351048 DOI: 10.30802/aalas-jaalas-18-000047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/31/2018] [Accepted: 07/02/2018] [Indexed: 11/05/2022]
Abstract
Mice routinely undergo surgical procedures for use in research; however, studies of skin preparation methods to achieve antisepsis are rare. The present study evaluated 4 skin preparation treatments: depilatory agent followed by povidone-iodine and alcohol scrub; depilatory agent followed by povidone-iodine and saline scrub; electric clippers followed by povidone-iodine and alcohol scrub; and electric clippers followed by povidone-iodine and saline scrub. Swabs for bacterial culture were obtained immediately after hair removal and after scrubbing to measure the reduction in bacterial load. Full-thickness incisions were assigned ASEPSIS wound scores and examined histologically on days 0, 1, and 7 after surgery. Neither bacterial load growth nor ASEPSIS wound scores differed among any of the treatments. Histopathology revealed statistically significant but biologically irrelevant differences. Overall all treatment methods achieved acceptable bacterial load reduction and surgical site healing.
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Affiliation(s)
- Brenda L Kick
- Division of Animal Resources, Emory University, Atlanta, Georgia;,
| | - Sanjeev Gumber
- Division of Pathology, Yerkes National Primate Research Center, Atlanta, Georgia, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Heqiong Wang
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Emory University, Atlanta, Georgia
| | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Emory University, Atlanta, Georgia
| | - Douglas K Taylor
- Division of Animal Resources, Emory University, Atlanta, Georgia, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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Melekwe GO, Uwagie-Ero EA, Zoaka HA, Odigie EA. Comparative clinical effectiveness of preoperative skin antiseptic preparations of chlorhexidine gluconate and povidone iodine for preventing surgical site infections in dogs. Int J Vet Sci Med 2018; 6:113-116. [PMID: 30255087 PMCID: PMC6149254 DOI: 10.1016/j.ijvsm.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 01/10/2023] Open
Abstract
Contamination of surgical sites often resulting from inadequate surgical site preparation and poor asepsis is a common cause of surgical site infection (SSI) and postoperative complications. Standard practice ensuring preoperative skin disinfection helps to prevent the incidence of SSI. The choice of antiseptic therefore poses a serious counterbalance for the surgeon. This study was carried out to determine whether skin asepsis immediately prior to surgical site incision will reduce skin microbial burden that may potentiate the incidence of SSI and to compare the clinical effectiveness of chlorhexidine gluconate B.P 0.3%W/V, Cetrimide B.P 3.05 W/V (CG + Cetrimide) against povidone iodine 10% (PI) in pre-surgical skin preparation and asepsis in dogs. A total of 15 dogs were used for the study. Both side of each dog was used for the study, right side for CG + Certrimide and left side for PI; (n = 30). Aseptic agents’ chlorhexidine gluconate 0.3% and Cetrimide 3.0% and povidine iodine 10% were used as pre surgical scrub solutions prior to surgery. Swab samples were evaluated before scrubbing, 0, 30, 60 and 90 min after scrubbing. Percent reductions of bacterial colony forming units were determined for all site scrub techniques. Mixed-design ANOVA results revealed significant difference (P < 0.05) within groups and no significant difference (P > 0.05) in the disinfectant effects between groups treated with CG + Cetrimide and povidone iodine respectively across the various time periods. Changes in the mean bacteria count were observed to be equivalent using CG + Cetrimide and povidone iodine. It was concluded that there was no significant difference between CG + Cetrimide and PI in preoperative surgical skin preparations.
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Affiliation(s)
- Gladys O Melekwe
- Department of Surgery, Faculty of Veterinary Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Edwin A Uwagie-Ero
- Department of Surgery, Faculty of Veterinary Medicine, University of Benin, Benin City, Nigeria
| | - Hassan A Zoaka
- Department of Surgery, Faculty of Veterinary Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Eugene A Odigie
- Department of Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Benin, Benin City, Nigeria
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Abstract
INTRODUCTION Surgical site infections (SSI) are a public health issue. The purpose of this review is to review the literature on methods of pre-operative skin preparation for the prevention of SSI in abdominal surgery. METHODS In order to obtain the best level of evidence, only meta-analyses and randomized controlled clinical trials were selected from the Cochrane Library and PubMed databases. High-powered non-randomized studies were included when results were not available for the questions asked. The primary endpoint was the rate of SSI within 30 days. RESULTS Analysis of the 20 selected studies suggested that hair removal in the operative field is not recommended except when it interferes with surgery; in this case, hair clipping or chemical depilation is recommended and shaving should be banned. For the pre-operative shower, the choice of a detergent product with or without antiseptic does not seem to matter, and there were no published data on the required number of showers or the interval before surgery. Application of an alcohol-based solution to the operative field for cutaneous disinfection is recommended; the products used seem to be equivalent, and there is no need for pre-operative detergent scrubbing. There is no strong evidence to recommend adhesive plastic drapes for clean or contaminated surgery. CONCLUSION Some recommendations on skin preparation before abdominal surgery to reduce the rate of SSI are based on a high level of evidence. Other recommendations such as the number and duration of pre-operative showers or use of adhesive plastic skin drapes are less well supported.
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Affiliation(s)
- K Poirot
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - B Le Roy
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - L Badrikian
- Service d'hygiène hospitalière, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - K Slim
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
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Zhang D, Wang XC, Yang ZX, Gan JX, Pan JB, Yin LN. RETRACTED: Preoperative chlorhexidine versus povidone-iodine antisepsis for preventing surgical site infection: A meta-analysis and trial sequential analysis of randomized controlled trials. Int J Surg 2017; 44:176-184. [PMID: 28583892 DOI: 10.1016/j.ijsu.2017.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/01/2017] [Indexed: 12/27/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor of the Journal. The retraction has been made because the Editor has been informed that a similar article containing the same research was submitted to another journal by other authors. The authors have admitted errors in drafting and submitting the paper and apologise for the mistakes.
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Affiliation(s)
- Dan Zhang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730030, Gansu Province, China
| | - Xi-Chen Wang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730030, Gansu Province, China
| | - Zeng-Xi Yang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730030, Gansu Province, China
| | - Jian-Xin Gan
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730030, Gansu Province, China
| | - Jie-Bin Pan
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730030, Gansu Province, China
| | - Lan-Ning Yin
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730030, Gansu Province, China
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Hinchliffe RJ, Earnshaw JJ. Surgical infection. Br J Surg 2017; 104:e8-e10. [PMID: 28121043 DOI: 10.1002/bjs.10468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022]
Abstract
Real and present danger
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Affiliation(s)
- R J Hinchliffe
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J J Earnshaw
- Department of Vascular Surgery, Cheltenham General Hospital, Sandford Road, Cheltenham, UK
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Brookman-May SD, Mir MC, May M, Klatte T. Clinical Trials and Their Principles in Urologic Oncology. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_54-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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