Bacterial recolonization of the skin under a polyurethane drape in hip surgery

Foreign Body Reaction to Ion-Beam-Treated Polyurethane Implant

All artificial materials used for implantation into an organism cause a foreign body reaction. This is an obstacle for a number of medical technologies. In this work, we investigated the effect of high-energy ion bombardment on polyurethane for medical purposes and the reaction of body tissues to its insertion into the mouse organism. An analysis of the cellular response and shell thickness near the implant showed a decrease in the foreign body reaction for implants treated with high-energy ions compared to untreated implants. The decrease in the reaction is associated with the activation of the polyurethane surface due to the formation on the surface layer of condensed aromatic clusters with unbonded valences on the carbon atoms at the edges of such clusters and the covalent attachment of the organism's own proteins to the activated surface of the implant. Thus, immune cells do not identify the implant surface coated with its own proteins as a foreign body. The deactivation of free valences at the edges of aromatic structures due to the storage of the treated implant before surgery reduces surface activity and partially restores the foreign body response. For the greatest effect in eliminating a foreign body reaction, it is recommended to perform the operation immediately after treating the implant with high-energy ions, with minimal contact of the treated surface with any materials.

Surgical Site Infections

Surgical site infections (SSIs) are among the most common and most costly health care-associated infections, leading to adverse patient outcomes and death. Wound contamination occurs with each incision, but proven strategies exist to decrease the risk of SSI. In particular, improved adherence to evidence-based preventive measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI. Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSI.

Contemporary Review to Reduce Groin Surgical Site Infections in Vascular Surgery

Surgical site infection (SSIs) in lower extremity vascular procedures is a major contributor to patient morbidity and mortality. Despite previous advancements in preoperative and postoperative care, the surgical infection rate in vascular surgery remains high, particularly when groin incisions are involved. However, successfully targeting modifiable risk factors reduces the surgical site infection incidence in vascular surgery patients. We conducted an extensive literature review to evaluate the efficacy of various preventive strategies for groin surgical site infections. We discuss the role of preoperative showers, preoperative and postoperative antibiotics, collagen gentamicin implants, iodine impregnated drapes, types of skin incisions, negative pressure wound therapy, and prophylactic muscle flap transposition in preventing surgical site infection in the groin after vascular surgical procedures.

A Prospective Comparative Study in Skin Antiseptic Solutions for Posterior Spine Surgeries: Chlorhexidine-Gluconate Ethanol Versus Povidone-Iodine

STUDY DESIGN

This is a prospective comparative study.

OBJECTIVE

We evaluated the efficacy of 2 standard antiseptic solutions, chlorhexidine-gluconate (CHG) and povidone-iodine (PD-I), in eliminating bacterial pathogens from surgical sites in posterior spine surgeries.

SUMMARY OF BACKGROUND DATA

Previous studies have shown that CHG is more effective for skin antisepsis than PD-I in joint surgeries. However, few studies have investigated the preoperative use of antiseptic solutions in spine surgery.

MATERIALS AND METHODS

A total of 190 patients who received posterior spine surgeries were included in this study. The patients were allocated to the group treated with 0.5% CHG in ethanol (N=98) or 10% PV-I (N=92). Sterile culture swabs were used to obtain samples from the skin area adjacent to the planned incision site before preparation, after preparation, and after wound closure.

RESULTS

No differences were found between the CHG-treated and the PD-I-treated groups in the patients' age, sex, disease status, surgical site, operating time, and intraoperative blood loss. Before surgical skin preparation, bacteria grew in the cultures of specimens of 83.7% of the patients; no significant difference was found between the 2 groups. The common organisms isolated from both the cervical and lumbar spine surgical sites were Staphylococcus sp., Corynebacterium sp., and Bacillus sp. After the skin preparation, there were no significant differences observed in the culture positive rate between the CHG (3.1%) and PD-I (5.1%) (P=0.49) solutions. The culture positive rates became higher after wound closure (preop=4.2%, postop=8.4%; P=0.07). The positive rate after wound closure in the CHG-treated group (5.1%) was smaller than in the PD-I-treated group (14.1%) (P=0.046). However, no difference was found in infection rates between the 2 groups.

CONCLUSIONS

While CHG-ethanol and PD-I were equally effective at eliminating the bacterial flora from the surgical site, CHG-ethanol showed a more favorable long-lasting effect for skin antisepsis in posterior spine surgeries.

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

Background and purpose - Iodine-impregnated incision drapes (IIIDs) are used to prevent surgical site infection (SSI). However, there is some evidence to suggest a potential increase in SSI risk as a result of IIID use, possibly from promotion of skin recolonization. A greater number of viable bacteria in the surgical field of an arthroplasty, and surgery in general, may increase the infection risk. We investigated whether IIID use increases bacterial recolonization compared to no drape use under conditions of simulated total knee arthroplasty (TKA). Methods - 20 patients scheduled for TKA were recruited. Each patient had 1 knee randomized for draping with IIID, while the contralateral knee was left bare. The patients thus served as their own control. The operating room conditions and perioperative procedures of a TKA were simulated. Cylinder samples were collected from the skin of each knee prior to disinfection, and again on 2 occasions after skin preparation-75 min apart. Quantities of bacteria were estimated using a spread plate technique under aerobic conditions. Results - We found similar quantities of bacteria on the intervention and control knees immediately after skin disinfection and after 75 min of simulated surgery. These quantities had not increased at the end of surgery when compared to baseline, so no recolonization was detected on the draped knees or on the bare knees. Interpretation - The use of IIIDs did not increase bacterial recolonization in simulated TKA. This study does not support the hypothesis that IIIDs promote bacterial recolonization and postoperative infection risk.

Cyanoacrylate microbial sealants for skin preparation prior to surgery

BACKGROUND

Surgical site infections (i.e. incisions that become infected) are a continuing concern in health care. Microbial sealant is a liquid that can be applied to the skin immediately before surgery and is thought to help reduce the incidence of surgical site infections (SSIs) by sealing in the skin flora, thus preventing contamination and infection of the surgical site.

OBJECTIVES

To assess the effects of the preoperative application of microbial sealants (compared with no microbial sealant) on rates of SSI in people undergoing clean surgery.

SEARCH METHODS

For this second update we searched the following electronic databases in May 2015: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions based on language or date of publication or study setting.

SELECTION CRITERIA

Randomised controlled trials (RCTs) were eligible for inclusion if they involved people undergoing clean surgery (i.e. surgery that does not involve the breathing system, gut, genital or urinary tract, or any part of the body with an existing infection) in an operating theatre and compared the use of preoperative microbial sealants with no microbial sealant.

DATA COLLECTION AND ANALYSIS

All review authors independently extracted data on the characteristics, risk of bias and outcomes of the eligible trials.

MAIN RESULTS

Seven trials (859 participants undergoing clean surgery) met the inclusion criteria. The trials all compared cyanoacrylate microbial sealant with no sealant. We found there were fewer SSIs with the use of microbial sealant (23/443 participants) than with the control comparison (46/416 participants). There was no evidence of a difference between the two groups in surgical site infection rates following the use of microbial sealants when the results were pooled (risk ratio (RR) 0.53, 95% CI 0.24 to 1.18). There were adverse events in three studies, but these were not judged to be a result of the use of microbial sealant.

AUTHORS' CONCLUSIONS

In this second update there is still insufficient evidence available to determine whether the use of microbial sealants reduces the risk of surgical site infection or not. Further rigorous, adequately-powered RCTs are required to investigate this properly.

Use of plastic adhesive drapes during surgery for preventing surgical site infection

BACKGROUND

Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach. A systematic review was required to guide clinical practice.

OBJECTIVES

To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity.

SEARCH METHODS

For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 4th March 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid MEDLINE (2012 to 3rd March 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 2012 to 3rd March 2015); Ovid EMBASE (2012 to 3rd March 2015); and EBSCO CINAHL (2012 to 4th March 2015).

SELECTION CRITERIA

Randomised controlled trials comparing any plastic adhesive drape with no plastic adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes, in patients undergoing any type of surgery. Ring drapes were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected and assessed studies for trial quality and both independently extracted data. We contacted study authors for additional information.

MAIN RESULTS

We identified no new studies for this fourth update. The review includes five studies involving 3082 participants comparing plastic adhesive drapes with no drapes and two studies involving 1113 participants comparing iodine-impregnated adhesive drapes with no drapes. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drapes (risk ratio (RR) 1.23, 95% confidence interval (CI) 1.02 to 1.48, P = 0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.06 to 1.66, P = 0.89). Length of hospital stay was similar in the adhesive drape and non-adhesive drape groups.

AUTHORS' CONCLUSIONS

There was no evidence from the seven trials that plastic adhesive drapes reduce surgical site infection rates, and some evidence that they increase infection rates. Further trials may be justified, using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection, based on different wound classifications.

Cyanoacrylate microbial sealants for skin preparation prior to surgery

BACKGROUND

Surgical site infections (i.e. incisions that become infected) are a continuing concern in health care. Microbial sealant is a liquid that can be applied to the skin immediately before surgery and is thought to help reduce the incidence of surgical site infections (SSIs) by sealing in the skin flora, thus preventing contamination and infection of the surgical site.

OBJECTIVES

To assess the effects of the preoperative application of microbial sealants (compared with no microbial sealant) on rates of SSI in people undergoing clean surgery.

SEARCH METHODS

For this first update we searched the following electronic databases in July 2013: the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE - In-Process & Other Non-Indexed Citations, Ovid EMBASE and EBSCO CINAHL.

SELECTION CRITERIA

Randomised controlled trials (RCTs) were eligible for inclusion if they involved people undergoing clean surgery (i.e. surgery that does not involve the breathing system, gut, genital or urinary tract or any part of the body with an existing infection) in an operating theatre and compared the use of preoperative microbial sealants with no microbial sealant.

DATA COLLECTION AND ANALYSIS

All review authors independently extracted data on the characteristics, risk of bias and outcomes of the eligible trials.

MAIN RESULTS

Three trials (524 participants undergoing clean surgery) met the inclusion criteria. The trials all compared cyanoacrylate microbial sealant with no sealant, and, when pooled, we found there were fewer SSIs with the use of microbial sealant (10/261 participants) than with the control comparison (29/274 participants). The difference between the two groups was statistically significant (risk ratio (RR) 0.36, 95% CI 0.18 to 0.72) but given the number of participants and quality of the studies, they should be treated with caution. There were some adverse events in one study, but these were not judged to be a result of the use of microbial sealant.

AUTHORS' CONCLUSIONS

In this first update there is still insufficient evidence available to determine whether the use of microbial sealants reduces the risk of surgical site infection or not. Further rigorous, adequately-powered RCTs are required to investigate this properly.

Use of plastic adhesive drapes during surgery for preventing surgical site infection

BACKGROUND

Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach, but no systematic review has been conducted to date to guide clinical practice.

OBJECTIVES

To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity.

SEARCH METHODS

For this third update we searched the Cochrane Wounds Group Specialised Register (searched 19 July 2012); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); Ovid MEDLINE (1946 to July Week 2, 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 18, 2012); Ovid EMBASE (1974 to Week 28, 2012); and EBSCO CINAHL (1982 to July 6, 2012).

SELECTION CRITERIA

Randomised controlled trials comparing any plastic adhesive drape with no plastic adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes, in patients undergoing any type of surgery.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected and assessed studies for trial quality and both independently extracted data. We contacted study authors for additional information.

MAIN RESULTS

We identified no new studies for this third update. The review includes five studies involving 3082 participants comparing plastic adhesive drapes with no drapes and two studies involving 1113 participants comparing iodine-impregnated adhesive drapes with no drapes. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drapes (risk ratio (RR) 1.23, 95% confidence interval (CI) 1.02 to 1.48, P = 0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.06 to 1.66, P = 0.89). Length of hospital stay was similar in the adhesive drape and non-adhesive drape groups.

AUTHORS' CONCLUSIONS

There was no evidence from the seven trials that plastic adhesive drapes reduce surgical site infection rates, and some evidence that they increase infection rates. Further trials may be justified, using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection, based on different wound classifications.

Cyanoacrylate microbial sealants for skin preparation prior to surgery

BACKGROUND

Surgical site infections are a continuing concern in health care. Microbial sealant is a liquid applied to the skin immediately before surgery. It is thought to contribute to reducing surgical site infections by sealing in the skin flora to prevent contamination and infection of the surgical site.

OBJECTIVES

To assess the effects of the preoperative application of microbial sealants (compared with no microbial sealant) on the rates of surgical site infection in people undergoing clean surgery.

SEARCH STRATEGY

We searched the Cochrane Wounds Group Specialised Register (searched 10 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), Ovid MEDLINE (1950 to April Week 3 2010), Ovid MEDLINE - In-Process & Other Non-Indexed Citations (searched 10 May 2010), Ovid EMBASE (1980 to 2010 Week 18) and EBSCO CINAHL (1982 to 10 May 2010). We searched bibliographies and contacted manufacturers of microbial sealants for unpublished studies. There were no restrictions based on language, date or publication status.

SELECTION CRITERIA

Randomised controlled trials (RCTs) were eligible for inclusion if they involved people undergoing clean surgery in an operating theatre and compared the use of preoperative microbial sealants with no microbial sealant.

DATA COLLECTION AND ANALYSIS

All review authors independently extracted data on the characteristics, risk of bias and outcomes of the eligible trial.

MAIN RESULTS

One small trial (177 participants undergoing hernia repair) met the inclusion criteria. There was no statistically significant difference in the rates of surgical site infection (three patients in the control group developed a surgical site infection compared with none in the intervention group; risk ratio (RR) 0.17, 95% CI 0.01 to 3.19, P = 0.23).

AUTHORS' CONCLUSIONS

There is currently insufficient evidence as to whether the use of microbial sealants reduces the risk of surgical site infection in people undergoing clean surgery and further rigorous RCTs are required.

Use of plastic adhesive drapes during surgery for preventing surgical site infection

BACKGROUND

Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach but no systematic review has been conducted to date to guide clinical practice.

OBJECTIVES

To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity.

SEARCH STRATEGY

We searched the Cochrane Wounds Group Specialised Register (last searched 24/4/07), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2,2007), Ovid MEDLINE (1950 to April Week 2, 2007), Ovid EMBASE (1980 to 2007 Week 16), and Ovid CINAHL (1982 to 1980 to April Week 2 2007).

SELECTION CRITERIA

Randomised controlled trials comparing any plastic adhesive drape with no adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes in patients undergoing any type of surgery.

DATA COLLECTION AND ANALYSIS

Two authors independently selected and assessed studies for trial quality and both independently extracted data. Study authors were contacted for additional information.

MAIN RESULTS

This review includes five studies involving 3,082 participants comparing adhesive drapes with no drape and two studies involving 1,113 participants comparing iodine-impregnated adhesive drapes with no drape. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drape. (Relative Risk (RR) 1.23, 95% Confidence Intervals (CI) 1.02 to 1.48, p=0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.064 to 1.66, p=0.89). Length of hospital stay was similar in adhesive drape and non-adhesive drape groups.

AUTHORS' CONCLUSIONS

There was no evidence from the seven trials that plastic adhesive drapes reduces surgical site infection rate and some evidence that they increase infection rates. Further trials may be justified using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection based on different wound classifications.

General principles of surgery applied to cattle

Basic principles of surgery are important to review, even for experienced surgeons. Although aseptic surgical principles are not always applicable in the field, we have to respect some guidelines. Recent research will influence the way that we do things, based on what we have been taught and our experience. Respecting those simple principles can make a big difference in the final outcome.

Results of preprocedure and postprocedure toe cultures in orthopaedic surgery

This study was to determine whether there is any benefit to wrapping the toes sterilely during orthopaedic procedures not involving the foot but performed on the lower extremity. The group studied consisted of 12 patients who had an orthopaedic procedure performed in which the foot and toes were included in the surgical prep, but not involved in the surgical procedure. Nine of the 12 patients (75%) had positive results from preprocedural aerobic cultures and two of the 12 (16.6%) had positive results from preprocedural fungal cultures. Recolonization of the bacteria between the toes was also demonstrated. Sterile draping of the toes would minimize the risk of infection and also protect against bacteria that recolonize during the procedure.