Peter Z Xu1, John R Fowler2, Robert J Goitz2. 1. 1 University of Pittsburgh School of Medicine, PA, USA. 2. 2 Department of Orthopaedics, University of Pittsburgh, PA, USA.
Abstract
BACKGROUND: Decontamination of the skin prior to incision is part of the standard of care for any surgical procedure. Previous studies have demonstrated variable efficacy of different surgical preparation solutions based on anatomic location. The purpose of this study is to determine the effectiveness of 3 commonly used surgical preparation solutions in eliminating bacteria from the skin prior to incision for common elective soft tissue hand procedures. METHODS: A total of 240 patients undergoing clean, elective, soft tissue hand surgery were prospectively randomized to 1 of 3 groups (ChloraPrep, DuraPrep, or Betadine). Prepreparation and postpreparation cultures were obtained adjacent to the surgical incision and neutralization was performed on the obtained specimen. Cultures were held for 14 days and patients followed for 6 weeks postoperatively. RESULTS: Postpreparation cultures were positive in 21 of 80 (26.3%) ChloraPrep patients, 3 of 79 (3.8%) DuraPrep patients, and 1 of 81 (1.2%) Betadine patients ( P < .001). There was no difference in the postpreparation culture rate between DuraPrep and Betadine ( P = 1.000). CONCLUSIONS:Duraprep and Betadine were found to be superior to Chloraprep for skin decontamination prior to clean elective soft tissue hand surgery. The bacterial flora of the hand was found to be different from those of the shoulder and spine. The clinical significance of this finding requires clinical consideration because the majority of prepreparation and postpreparation positive cultures were of Bacillus species, which are rarely a cause of postoperative infections.
RCT Entities:
BACKGROUND: Decontamination of the skin prior to incision is part of the standard of care for any surgical procedure. Previous studies have demonstrated variable efficacy of different surgical preparation solutions based on anatomic location. The purpose of this study is to determine the effectiveness of 3 commonly used surgical preparation solutions in eliminating bacteria from the skin prior to incision for common elective soft tissue hand procedures. METHODS: A total of 240 patients undergoing clean, elective, soft tissue hand surgery were prospectively randomized to 1 of 3 groups (ChloraPrep, DuraPrep, or Betadine). Prepreparation and postpreparation cultures were obtained adjacent to the surgical incision and neutralization was performed on the obtained specimen. Cultures were held for 14 days and patients followed for 6 weeks postoperatively. RESULTS: Postpreparation cultures were positive in 21 of 80 (26.3%) ChloraPreppatients, 3 of 79 (3.8%) DuraPreppatients, and 1 of 81 (1.2%) Betadinepatients ( P < .001). There was no difference in the postpreparation culture rate between DuraPrep and Betadine ( P = 1.000). CONCLUSIONS:Duraprep and Betadine were found to be superior to Chloraprep for skin decontamination prior to clean elective soft tissue hand surgery. The bacterial flora of the hand was found to be different from those of the shoulder and spine. The clinical significance of this finding requires clinical consideration because the majority of prepreparation and postpreparation positive cultures were of Bacillus species, which are rarely a cause of postoperative infections.
Authors: James S Harrop; John C Styliaras; Yinn Cher Ooi; Kristen E Radcliff; Alexander R Vaccaro; Chengyuan Wu Journal: J Am Acad Orthop Surg Date: 2012-02 Impact factor: 3.020
Authors: Aaron J Johnson; Jacqueline A Daley; Michael G Zywiel; Ronald E Delanois; Michael A Mont Journal: J Arthroplasty Date: 2010-05-31 Impact factor: 4.757
Authors: Michael R Bykowski; Wesley N Sivak; James Cray; Glenn Buterbaugh; Joseph E Imbriglia; W P Andrew Lee Journal: J Hand Surg Am Date: 2011-10-05 Impact factor: 2.230
Authors: Jean Jacques Parienti; Pascal Thibon; Remy Heller; Yannick Le Roux; Peter von Theobald; Henri Bensadoun; Alain Bouvet; François Lemarchand; Xavier Le Coutour; Hervé Bensadoun Journal: JAMA Date: 2002-08-14 Impact factor: 56.272
Authors: Brian R Swenson; Traci L Hedrick; Rosemarie Metzger; Hugo Bonatti; Timothy L Pruett; Robert G Sawyer Journal: Infect Control Hosp Epidemiol Date: 2009-10 Impact factor: 3.254