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

Small animal patient preoperative preparation: a review of common antiseptics, comparison studies, and resistance

This review aims to describe commonly used antiseptics in veterinary medicine including their mechanism of action, spectrum of activity, potential adverse effects, and application techniques. Additionally, it provides a review of the veterinary literature comparing antiseptics, a discussion of effectiveness and efficacy studies, and the potential for increased resistance to biocides and antimicrobials. This review concludes that appropriate selection and use is necessary to prevent the occurrence of surgical site infections, adverse effects, and potential for increasing resistance to antimicrobials. Continued research is needed to fill gaps in the current knowledge such as optimal preparation procedures for various surgical sites, standardization of efficacy and effectiveness testing, and the clinical impact of decreased susceptibility to chlorhexidine and other antiseptics.

Efficiency of octenidine dihydrochloride alcohol combination compared to ethanol based skin antiseptics for preoperative skin preparation in dogs

OBJECTIVE

To quantify the bacterial burden after skin disinfection using an alcohol octenidine dihydrochloride combination (Octenisept®) compared to an 74.1% ethanol 10% 2-propanol combination (Softasept N®).

STUDY DESIGN

Prospective randomized clinical trial.

MATERIAL & METHODS

61 dogs undergoing clean or clean-contaminated surgeries (excluding surgeries on the gastrointestinal tract) were randomly assigned to group O (skin disinfection with alcohol and octenidine dihydrochloride after washing with octenidine containing soap) or to control group C (skin disinfection using the ethanol-2-propanol combination after washing with a neutral soap without antiseptic ingredients). Samples were then taken from 8 different locations within the surgical field at four different stages: after clipping, after washing, after disinfection and one hour later. At each stage, two different sampling techniques (wet-dry swab technique (WDS) and contact plates (CP)) were used for quantitative analysis of bacterial counts.

RESULTS

WDS detected about 100-fold more bacteria compared to CP sampling in cases with high bacterial burden, but was not accurate enough to detect small numbers. CP sampling was therefore used for comparison of treatment protocols. 30 dogs were assigned to group O and 31 to group C. A relative reduction of 69% in group O and 77 percent in group C was observed after the soap wash. No significant differences were detected between both groups. Washing and disinfection resulted in a reduction of bacterial counts of 99.99% in group O versus 99.7% in group C (p = 0.018). Bacterial reduction one hour after washing and disinfection was significantly higher in group O (99.9%) than in group C (98.5%, p = 0.001).

CONCLUSION

Additional octenidine dihydrochloride provided a slightly better decontamination effect after disinfection, particularly one hour after, which means it may only be indicated in longer surgeries. WDS is more sensitive but less specific to detect bacteria on the skin than the CP sampling.

Influence of clipping on bacterial contamination of canine arthrocentesis sites before and after skin preparation

OBJECTIVE

To determine the influence of hair removal as part of the aseptic skin preparation of canine arthrocentesis sites and to characterize the bacterial flora remaining after aseptic skin preparation.

STUDY DESIGN

Randomized controlled trial.

STUDY POPULATION

Thirteen shorthaired beagle-cross dogs.

METHODS

A coin toss was used to randomly determine to have one carpus, elbow, tarsus, and stifle clipped. The contralateral side was left unclipped. Aseptic skin preparation was performed on all sites with 4% chlorhexidine followed by 70% isopropyl alcohol. The skin of each site was sampled for aerobic and anaerobic bacterial cultures before and after aseptic skin preparation. Bacterial cultures were submitted for laboratory testing to determine the colony-forming units (CFU) of bacteria and bacterial species isolated for each site.

RESULTS

Each group (clipped and unclipped) included 52 sites. Aseptic skin preparation reduced bacterial CFU in both groups. There was no association between values for CFU per milliliter after skin preparation of dogs and side (P = .07), joint (P = .71), pre-aseptic skin preparation CFU (P = .94), or clipping (P = .42). Staphylococcus spp were the most common of the bacterial species cultured.

CONCLUSION

In clean shorthaired dogs without visible evidence of dermatological disease, leaving arthrocentesis sites unclipped rather than performing traditional surgical clipping did not result in increased bacterial skin counts after aseptic skin preparation.

CLINICAL SIGNIFICANCE

In this study we did not find evidence to support that clipping of canine arthrocentesis sites is required for effective aseptic skin preparation. A prospective clinical trial is required to determine whether a change in practice would be associated with increased morbidity.