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Burchard R, Sayn L, Schmidt R, Graw JA, Scheicher T, Soost C, Gruenewald A. The Level of Surface Coverage of Surgical Site Disinfection Depends on the Visibility of the Antiseptic Agent-A Virtual Reality Randomized Controlled Trial. J Clin Med 2023; 12:1472. [PMID: 36836006 PMCID: PMC9961233 DOI: 10.3390/jcm12041472] [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] [Received: 01/19/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) have a significant impact on outcome associated with surgical treatment. Therefore, skin antisepsis has evolved as a standard preoperative procedure in the operating room to reduce the perioperative risk of an SSI. In their "Global Guidelines for the prevention of surgical site infections", the World Health Organization (WHO) recommend the use of an agent with remanent additives and considers colored agents as helpful. However, colored and remanent disinfectants are not available in Germany. The aim of the present study was to investigate whether using a colored antiseptic solution increases the quality of preoperative skin antisepsis. METHODS This study was designed as a randomized, double-blinded controlled trial. To examine the level of coverage of skin antisepsis, an appropriate virtual reality (VR) environment was generated. Participants could see a movable surgical clamp with a swab in their hand. When touching the skin, the participants recognized an optical change in the appearance of the skin: Using a colored antiseptic solution resulted in orange-colored skin. Using an uncolored agent, a shiny wet look was visible without a change in natural skin color. RESULTS Data of 141 participants (female: 61.0% (n = 86); mean age: 28 y (Range 18-58 y, SD = 7.53 y)) were included in the study. The level of disinfection coverage was higher in the group using the colored disinfectant. On average, 86.5% (sd = 10.0) of the leg skin was covered when a colored disinfectant was used, whereas only 73.9% (sd = 12.8) of the leg skin was covered when the participants had to use an uncolored agent (p < 0.001, effect size: f = 0.56, η2 = 0.24). CONCLUSIONS The use of an uncolored disinfectant leads to a lower surface coverage of the perioperative skin disinfection. Thus far, it is unclear whether using uncolored disinfectants is associated with higher risks for perioperative infections compared with the use of non-remanent disinfectants. Therefore, further research is necessary and current German guidelines should be re-evaluated accordingly.
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Affiliation(s)
- Rene Burchard
- Department of Orthopedics and Trauma Surgery, University Hospital of Giessen and Marburg, 35043 Marburg, Germany
- Department of Orthopedics and Trauma Surgery, Lahn-Dill-Kliniken, 35683 Dillenburg, Germany
| | - Lukas Sayn
- Medical Informatics and Microsystems Engineering, University of Siegen, 57076 Siegen, Germany
| | - Ricardo Schmidt
- Medical Informatics and Microsystems Engineering, University of Siegen, 57076 Siegen, Germany
| | - Jan A. Graw
- Department of Anesthesiology and Intensive Care Medicine, Ulm University Hospital, 89081 Ulm, Germany
| | | | | | - Armin Gruenewald
- Medical Informatics and Microsystems Engineering, University of Siegen, 57076 Siegen, Germany
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Ammanuel SG, Edwards CS, Chan AK, Mummaneni PV, Kidane J, Vargas E, D’Souza S, Nichols AD, Sankaran S, Abla AA, Aghi MK, Chang EF, Hervey-Jumper SL, Kunwar S, Larson PS, Lawton MT, Starr PA, Theodosopoulos PV, Berger MS, McDermott MW. Are preoperative chlorhexidine gluconate showers associated with a reduction in surgical site infection following craniotomy? A retrospective cohort analysis of 3126 surgical procedures. J Neurosurg 2021; 135:1889-1897. [PMID: 33930864 PMCID: PMC9448162 DOI: 10.3171/2020.10.jns201255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) is a complication linked to increased costs and length of hospital stay. Prevention of SSI is important to reduce its burden on individual patients and the healthcare system. The authors aimed to assess the efficacy of preoperative chlorhexidine gluconate (CHG) showers on SSI rates following cranial surgery. METHODS In November 2013, a preoperative CHG shower protocol was implemented at the authors' institution. A total of 3126 surgical procedures were analyzed, encompassing a time frame from April 2012 to April 2016. Cohorts before and after implementation of the CHG shower protocol were evaluated for differences in SSI rates. RESULTS The overall SSI rate was 0.6%. No significant differences (p = 0.11) were observed between the rate of SSI of the 892 patients in the preimplementation cohort (0.2%) and that of the 2234 patients in the postimplementation cohort (0.8%). Following multivariable analysis, implementation of preoperative CHG showers was not associated with decreased SSI (adjusted OR 2.96, 95% CI 0.67-13.1; p = 0.15). CONCLUSIONS This is the largest study, according to sample size, to examine the association between CHG showers and SSI following craniotomy. CHG showers did not significantly alter the risk of SSI after a cranial procedure.
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Affiliation(s)
- Simon G. Ammanuel
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Caleb S. Edwards
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K. Chan
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Joseph Kidane
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Enrique Vargas
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Sarah D’Souza
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Amy D. Nichols
- Department of Hospital Epidemiology and Infection Control, University of California, San Francisco, California
| | - Sujatha Sankaran
- Department of Hospital Medicine, University of California, San Francisco, California
| | - Adib A. Abla
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Manish K. Aghi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Edward F. Chang
- Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Sandeep Kunwar
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Paul S. Larson
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael T. Lawton
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Philip A. Starr
- Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael W. McDermott
- Department of Neurological Surgery, University of California, San Francisco, California
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Stone J, Bianco A, Monro J, Overybey JR, Cadet J, Choi KH, Pena J, Robles BN, Mella MT, Matthews KC, Factor SH. Study To Reduce Infection Prior to Elective Cesarean Deliveries (STRIPES): a randomized clinical trial of chlorhexidine. Am J Obstet Gynecol 2020; 223:113.e1-113.e11. [PMID: 32407786 DOI: 10.1016/j.ajog.2020.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical site infections after cesarean delivery are a cause of maternal morbidity and are typically caused by skin microbial flora. Preadmission application of chlorhexidine gluconate using impregnated cloths may decrease surgical site infections by decreasing the abundance of microbial flora. OBJECTIVE To determine whether the application of chlorhexidine gluconate cloths the night before and the morning of scheduled cesarean delivery decreases the risk of surgical site infections by 6 weeks postoperatively compared with placebo. STUDY DESIGN In this single-center, double-blind, placebo-controlled trial, patients were randomized (1:1) to receive either Sage 2% chlorhexidine cloths or Sage Comfort Bath fragrance-free cloths (placebo) to apply to 6 skin sites on the body (neck, shoulders and chest, armpits, arm and hands, abdomen and groin, left leg and foot, right leg and foot, back and buttocks) the night before and after a shower the morning of scheduled cesarean delivery. Routine clinical and operative procedures were followed. The primary outcome was surgical site infections (superficial or deep incisional with or without organ space endometritis) by 6 weeks after cesarean delivery. The secondary outcomes were surgical site infections by 2 weeks and other wound-related complications by 2 and 6 weeks after cesarean delivery. RESULTS From April 2015 to August 2019, 1356 patients were enrolled: 682 were assigned to the chlorhexidine group and 674 to the placebo group. The groups were similar in demographic and medical characteristics. A total of 14 patients were lost to follow-up before cesarean delivery (10 in chlorhexidine and 4 in placebo) and 33 were lost to follow-up after cesarean delivery (10 in chlorhexidine and 23 in placebo). Among the remaining 1309 (97%), no difference was found in surgical site infections by 6 weeks between the 2 groups (2.6% in chlorhexidine vs 3.7% in placebo; P=.24). There were no differences in secondary outcomes at 2 or 6 weeks and no differences in primary outcome in a per-protocol analysis. CONCLUSION Preadmission use of chlorhexidine gluconate cloths compared with placebo does not reduce the risk of surgical site infection after scheduled cesarean deliveries. Following the standard of care guidelines results in a low risk of surgical site infections in this group of patients.
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Chan AK, Ammanuel SG, Chan AY, Oh T, Skrehot HC, Edwards CS, Kondapavulur S, Miller CA, Nichols AD, Liu C, Dhall SS, Clark AJ, Chou D, Ames CP, Mummaneni PV. Chlorhexidine Showers are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries. Neurosurgery 2020; 85:817-826. [PMID: 30590721 DOI: 10.1093/neuros/nyy568] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a common complication following spinal surgery. Prevention is critical to maintaining safe patient care and reducing additional costs associated with treatment. OBJECTIVE To determine the efficacy of preoperative chlorhexidine (CHG) showers on SSI rates following fusion and nonfusion spine surgery. METHODS A mandatory preoperative CHG shower protocol was implemented at our institution in November 2013. A cohort comparison of 4266 consecutive patients assessed differences in SSI rates for the pre- and postimplementation periods. Subgroup analysis was performed on the type of spinal surgery (eg, fusion vs nonfusion). Data represent all spine surgeries performed between April 2012 and April 2016. RESULTS The overall mean SSI rate was 0.4%. There was no significant difference between the pre- (0.7%) and postimplementation periods (0.2%; P = .08). Subgroup analysis stratified by procedure type showed that the SSI rate for the nonfusion patients was significantly lower in the post- (0.1%) than the preimplementation group (0.7%; P = .02). There was no significant difference between SSI rates for the pre- (0.8%) and postimplementation groups (0.3%) for the fusion cohort (P = .21). In multivariate analysis, the implementation of preoperative CHG showers were associated with significantly decreased odds of SSI (odds ratio = 0.15, 95% confidence interval [0.03-0.55], P < .01). CONCLUSION This is the largest study investigating the efficacy of preoperative CHG showers on SSI following spinal surgery. In adjusted multivariate analysis, CHG showering was associated with a significant decrease in SSI following spinal surgery.
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Affiliation(s)
- Andrew K Chan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Simon G Ammanuel
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Alvin Y Chan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Taemin Oh
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Henry C Skrehot
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Caleb S Edwards
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Sravani Kondapavulur
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Catherine A Miller
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Amy D Nichols
- Department of Hospital Epidemiology and Infection Control, University of California, San Francisco, San Francisco, California
| | - Catherine Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Institute and Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Sanjay S Dhall
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Aaron J Clark
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Dean Chou
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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Asimus E, Palierne S, Blondel M, Pollet V, Ferran A, Bousquet-Melou A, Rousselot JF, Autefage A. Comparison of hydroalcoholic rubbing and conventional chlorhexidine scrubbing for aseptic skin preparation in dogs. Vet Surg 2019; 48:1466-1472. [PMID: 31034647 DOI: 10.1111/vsu.13222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 03/19/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare preparation time, ease of application, and elimination of skin contamination of 3 skin preparation methods for asepsis. STUDY DESIGN Experimental study. ANIMALS Healthy dogs (n = 6) with no clinical signs of skin disease. METHODS Three sites on each dog were randomly allocated to 1 of 3 preparation protocols for asepsis: (1) 5 scrubbings with chlorhexidine gluconate and rinsing (CHXG), (2) washing with mild soap prior to 3 rubbings with hydroalcoholic solution (soap-HAR), or (3) 3 rubbings with hydroalcoholic solution (HAR). The duration of each method of skin preparation was recorded. A Count-Tact agar plate was placed in the center of each site before, immediately after, 1 hour after, and 3 hours after antiseptic application. Plates were cultured, and colony forming units (CFU) were counted. RESULTS Skin preparation lasted an average of 375 seconds for CHXG, 240 seconds for soap-HAR, and 190 seconds for HAR (P = .00049). Nine CFU (median) were cultured from the skin prior to preparation, with no difference between sites on any animal or for any method. Colony forming units were not detected at any time on any site in any dog after antiseptic application. CONCLUSION Rubbing with hydroalcoholic (HA) solution was as effective as CHXG and prevented bacterial growth for at least 3 hours under these experimental conditions. Rubbing with hydroalcoholic solution was also faster and easier to perform. CLINICAL SIGNIFICANCE Because there is currently no known resistance to HA solution, preparation of the surgical site with HAR should be considered to prevent the emergence of bacterial resistance to chlorhexidine as well as potential cross-resistances to antibiotics. Transfer to clinical animals requires additional investigation.
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Affiliation(s)
- Erik Asimus
- Département des Sciences Cliniques, Unité de Chirurgie, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Sophie Palierne
- Département des Sciences Cliniques, Unité de Chirurgie, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Margaux Blondel
- Département des Sciences Cliniques, Unité de Chirurgie, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Valentine Pollet
- Département des Sciences Cliniques, Unité de Chirurgie, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Aude Ferran
- INTHERES, Université de Toulouse, INRA, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | - Alain Bousquet-Melou
- INTHERES, Université de Toulouse, INRA, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
| | | | - André Autefage
- Département des Sciences Cliniques, Unité de Chirurgie, Ecole Nationale Vétérinaire de Toulouse, Toulouse, France
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Harnoss JC, Assadian O, Kramer A, Probst P, Müller-Lantzsch C, Scheerer L, Bruckner T, Diener MK, Büchler MW, Ulrich AB. Comparison of chlorhexidine–isopropanol with isopropanol skin antisepsis for prevention of surgical-site infection after abdominal surgery. Br J Surg 2018; 105:893-899. [DOI: 10.1002/bjs.10793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/11/2017] [Accepted: 11/17/2017] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Prevention of surgical-site infection (SSI) has received increasing attention. Clinical trials have focused on the role of skin antisepsis in preventing SSI. The benefit of combining antiseptic chlorhexidine with alcohol has not been compared with alcohol-based skin preparation alone in a prospective controlled clinical trial.
Methods
Between August and October 2014, patients undergoing abdominal surgery received preoperative skin antisepsis with 70 per cent isopropanol (PA). Those treated between November 2014 and January 2015 received 2 per cent chlorhexidine with 70 per cent isopropanol (CA). The primary endpoint was SSI on postoperative day (POD) 10, which was evaluated using univariable analysis, and a multivariable logistic regression model correcting for known independent risk factors for SSI. The study protocol was published in the German Registry of Clinical Studies (DRKS00011174).
Results
In total, 500 patients undergoing elective midline laparotomy were included (CA 221, PA 279). The incidence of superficial and deep SSIs was significantly different on POD 10: 14 of 212 (6·6 per cent) among those treated with CA and 32 of 260 (12·3 per cent) in those who received PA (P = 0·038). In the multivariable analysis, skin antisepsis with CA was an independent factor for reduced incidence of SSI on POD 10 (P = 0·034).
Conclusion
This study showed a benefit of adding chlorhexidine to alcohol for skin antisepsis in reducing early SSI compared with alcohol alone.
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Affiliation(s)
- J C Harnoss
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - O Assadian
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - P Probst
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - C Müller-Lantzsch
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - L Scheerer
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M K Diener
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
| | - A B Ulrich
- Department of General, Visceral and Transplantation Surgery and Study Centre of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany
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Prepping the knee in maximal flexion: getting into every nook, cranny, and fold. Arthroplast Today 2017; 3:99-103. [PMID: 28695181 PMCID: PMC5484976 DOI: 10.1016/j.artd.2016.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/14/2016] [Accepted: 08/17/2016] [Indexed: 01/21/2023] Open
Abstract
This article describes a simple surgical skin preparation technique for total knee arthroplasty that permits the application of skin prep agent with the knee in maximal flexion. While most surgeons prep the knee in extension, it is believed that prep of the knee in flexion will provide superior coverage of the skin surface and reduce the potential for surgical-site infection, particularly in obese patients with large soft-tissue layers anterior to the knee.
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Mihaljevic AL, Schirren R, Müller TC, Kehl V, Friess H, Kleeff J. Postoperative negative-pressure incision therapy following open colorectal surgery (Poniy): study protocol for a randomized controlled trial. Trials 2015; 16:471. [PMID: 26482031 PMCID: PMC4617637 DOI: 10.1186/s13063-015-0995-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality, and remain one of the most frequent surgical complications. In prospective trials with adequate follow-up, more than 20 % of patients undergoing elective colorectal surgery are affected and methods to reduce surgical site infections are urgently needed. Negative-pressure incision therapy is a novel intervention that holds promise to reduce postoperative wound infection rates, but has not yet been rigorously tested in a randomized controlled trial. METHODS/DESIGN The aim is to investigate whether the postoperative application of a negative-pressure incision therapy device for 5-7 days reduces the rate of surgical site infections following open elective colorectal surgery by 50 %. This is a randomized, controlled, observer-blinded multicentre clinical trial with two parallel study groups. The primary outcome measure will be the rate of surgical site infections within 30 days postoperatively. Surgical site infections are defined according to criteria of the US Centers for Disease Control and Prevention. Statistical analysis of the primary endpoint measure will be based on the intention-to-treat population. The global level of significance is set at 5 % (two-sided) and the sample size (n = 170 per group) is determined to assure a power of 80 %. DISCUSSION The Poniy trial will explore whether the rate of surgical site infections can be reduced by the application of a negative-pressure incision therapy device in patients undergoing open elective colorectal surgery. Its pragmatic design guarantees high external validity and clinical relevance. TRIAL REGISTRATION Deutsches Register Klinischer Studien DRKS00006199 .
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Affiliation(s)
- André L Mihaljevic
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Rebekka Schirren
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Tara C Müller
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universtität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Jörg Kleeff
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München and CHIR-Net Munich, Ismaningerstrasse 22, 81675, Munich, Germany. .,Current affiliation: The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool L7 8XP, UK. .,Department of General-, Visceral- and Pediatric Surgery, University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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9
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Zhang MX, Sun YH, Xu Z, Zhou P, Wang HX, Wu YY. Wound edge protector for prevention of surgical site infection in laparotomy: an updated systematic review and meta-analysis. ANZ J Surg 2015; 85:308-14. [PMID: 25648953 DOI: 10.1111/ans.12997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ming-Xia Zhang
- Department of Infection Control; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Yi-Hui Sun
- Department of Infection Control; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Zheng Xu
- Department of Infection Control; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Ping Zhou
- Department of Infection Control; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Hong-Xia Wang
- Department of Library; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Yong-You Wu
- Department of General Surgery; The Second Affiliated Hospital of Soochow University; Suzhou China
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10
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Abstract
Recent debates and guidelines are suggesting back and forth motion to be the optimal preoperative technique for skin preparation. There is a lack of conclusive evidence showing this to be the case, but it may be reasonable to follow this technique, in preference to the widely used concentric circles motion, as the antiseptic agent will reach deeper cell layers of the skin where most of the microbes are found.
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11
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Yamamichi F, Shigemura K, Yamashita M, Tanaka K, Arakawa S, Fujisawa M. Postoperative wound dealing and superficial surgical site infection in open radical prostatectomy. Int Wound J 2014; 13:692-6. [PMID: 25186077 DOI: 10.1111/iwj.12348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/02/2014] [Accepted: 07/05/2014] [Indexed: 11/30/2022] Open
Abstract
The number of open radical prostatectomy (RP) surgeries has been decreasing owing to the spread of laparoscopic and robotic surgery, which has implications for postoperative wound healing. The purpose of this study was to investigate and document the current status of postoperative wound healing and superficial surgical site infection (SSI) in open RPs. One hundred and seventy-five antegrade RPs with the same or similar kinds of prophylactic antibiotic administration were divided into two groups: (i) 'no intervention' (wound covering group) and (ii) 'washing', using a washing solution from the second postoperative day to the day of skin staple removal (wound washing group). We compared these groups for the occurrence of superficial SSI. The wound covering group had three (3·03%) cases of superficial SSI, with one case caused by methicillin sensitive Staphylococcus aureus (MSSA). The wound washing group had nine (11·8%) cases of superficial SSI, with three cases caused by MSSA, two cases caused by methicillin resistant Staphylococcus aureus (MRSA) and one by Pseudomonas aeruginosa. The wound covering group showed a significantly lower ratio of superficial SSI (P = 0·0472). In conclusion, the postoperative wound status data in this study suggests that no wound intervention after RP resulted in a comparatively lower ratio of superficial SSI than in the wound washing group.
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Affiliation(s)
- Fukashi Yamamichi
- Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsumi Shigemura
- Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | | | - Kazushi Tanaka
- Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Soishi Arakawa
- Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Mihaljevic AL, Michalski CW, Erkan M, Reiser-Erkan C, Jäger C, Schuster T, Schuhmacher C, Kleeff J, Friess H. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO): study protocol for a randomized controlled trial. Trials 2012; 13:57. [PMID: 22587425 PMCID: PMC3533734 DOI: 10.1186/1745-6215-13-57] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 03/09/2012] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n = 258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010
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Affiliation(s)
- André L Mihaljevic
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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13
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No Risk of Surgical Site Infections From Residual Bacteria After Disinfection With Povidone-Iodine-Alcohol in 1014 Cases. Ann Surg 2012; 255:565-9. [DOI: 10.1097/sla.0b013e3182468b2d] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Noorani A, Rabey N, Walsh SR, Davies RJ. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone–iodine in clean-contaminated surgery. Br J Surg 2010; 97:1614-20. [DOI: 10.1002/bjs.7214] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Surgical-site infection increases morbidity, mortality and financial burden. The preferred topical antiseptic agent (chlorhexidine or povidone–iodine) for preoperative skin cleansing is unclear.
Methods
A meta-analysis of clinical trials was conducted to determine whether preoperative antisepsis with chlorhexidine or povidone–iodine reduced surgical-site infection in clean-contaminated surgery.
Results
The systematic review identified six eligible studies, containing 5031 patients. Chlorhexidine reduced postoperative surgical-site infection compared with povidone–iodine (pooled odds ratio 0·68, 95 per cent confidence interval 0·50 to 0·94; P = 0·019).
Conclusion
Chlorhexidine should be used preferentially for preoperative antisepsis in clean-contaminated surgery.
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Affiliation(s)
- A Noorani
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N Rabey
- Department of Plastic and Reconstructive Surgery, St Andrew's Centre, Broomfields Hospital, Chelmsford, UK
| | - S R Walsh
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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15
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Darouiche RO, Wall MJ, Itani KMF, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med 2010; 362:18-26. [PMID: 20054046 DOI: 10.1056/nejmoa0810988] [Citation(s) in RCA: 867] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine. METHODS We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections. RESULTS A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups. CONCLUSIONS Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)
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Affiliation(s)
- Rabih O Darouiche
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA.
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16
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Cousido M, Tomás M, Tomás I, Limeres J, García-Caballero L, Diz P. Effect of a neutralising agent on the evaluation of the antimicrobial activity of chlorhexidine on the bacterial salivary flora. Arch Oral Biol 2008; 53:981-4. [DOI: 10.1016/j.archoralbio.2008.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 03/24/2008] [Accepted: 04/23/2008] [Indexed: 11/25/2022]
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17
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Yoshida M, Nabeshima T, Gomi H, Lefor AT. Technology and the prevention of surgical site infections. JOURNAL OF SURGICAL EDUCATION 2007; 64:302-310. [PMID: 17961890 DOI: 10.1016/j.jsurg.2007.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 05/24/2007] [Accepted: 08/14/2007] [Indexed: 05/25/2023]
Affiliation(s)
- Makiko Yoshida
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Barie PS. Current Issues in the Prevention and Management of Surgical Site Infection. Surg Infect (Larchmt) 2006. [DOI: 10.1089/sur.2006.7.s3-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Philip S. Barie
- Departments of Surgery and Public Health, Division of Critical Care and Trauma, Weill Medical College of Cornell University, and Anne and Max A. Cohen Surgical Intensive Care Unit, NewYork-Presbyterian Hospital, Weill Cornell Center, New York, New York
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