Chlorhexidine–Alcohol Versus Povidone–Iodine for Surgical-Site Antisepsis

2021 ◽  
pp. 275-280
Author(s):  
Philipp Dahm
Keyword(s):  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Site Infection ◽  
Infection Rates ◽  
Surgical Infection ◽  
Space Infection ◽  
Small Intestinal ◽  
Clean Contaminated ◽  
Organ Space Infection

This chapter summarizes the landmark trial that examined, in patients undergoing clean-contaminated surgery, how chlorhexidine–alcohol scrub compared to povidone–iodine scrub and paint in terms of infection rates. The trial included patients who were undergoing colorectal, small intestinal, gastroesophageal, biliary, thoracic, gynecologic, or urologic operations without substantial spillage or unusual contamination. Chlorhexidine reduced the rate of any surgical infection as well as that of superficial incisional infection, but no difference was observed for deep incisional infections, organ space infection, and sepsis from surgical-site infection.

Comparison of the Risk of Surgical Site Infection After Laparoscopic Cholecystectomy and Open Cholecystectomy

2007 ◽  
Vol 28 (9) ◽  
pp. 1103-1106 ◽  
Author(s):  
Fernando M. Biscione ◽  
Renato C. Couto ◽  
Tânia M. Pedrosa ◽  
Mozar C. Neto
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Site Infection ◽  
Lower Risk ◽  
Open Cholecystectomy ◽  
Infection Risk ◽  
Surgical Patient ◽  
Site Infection ◽  
Space Infection ◽  
Organ Space Infection ◽  
Reduced Risk

We assessed the independent contributions of the surgical approach and other variables of the National Nosocomial Infections Surveillance System (NNIS) surgical patient component to the surgical site infection risk after cholecystectomy. Laparoscopic cholecystectomy was associated with a lower overall risk of surgical site infection and a lower risk of incisional infection but not a reduced risk of organ-space infection, compared with open cholecystectomy. The contribution of most of the variables of the NNIS surgical patient component to the risk of surgical site infection depended on the depth of the infection.

scholarly journals Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery

2021 ◽  
Author(s):  
Rolando Figueroa Roberto ◽  
Flynn Andrew Rowan ◽  
Deepak Nallur ◽  
Blythe Durbin-Johnson ◽  
Yashar Javidan ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Povidone Iodine ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Site Infection ◽  
Infection Rates ◽  
Vancomycin Powder

Abstract Background Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. Methods We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model. Results 475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied. Conclusions A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures. Level of evidence Level II.

scholarly journals Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates A Prospective Study of 3 Skin Preparation Protocols

2009 ◽  
Vol 30 (10) ◽  
pp. 964-971 ◽  
Author(s):  
Brian R. Swenson ◽  
Traci L. Hedrick ◽  
Rosemarie Metzger ◽  
Hugo Bonatti ◽  
Timothy L. Pruett ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
General Surgery ◽  
Isopropyl Alcohol ◽  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Skin Preparation ◽  
Improvement Project ◽  
Period 2

Objective.To compare the effects of different skin preparation solutions on surgical-site infection rates.Design.Three skin preparations were compared by means of a sequential implementation Design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% Chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner.Setting.Single large academic medical center.Patients.All adult general surgery patients.Results.The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% Chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001).Conclusions.Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to Chlorhexidine for this purpose in general surgery patients.

scholarly journals Incidence of surgical site infection in dogs undergoing soft tissue surgery: risk factors and economic impact

2019 ◽  
Vol 6 (1) ◽  
pp. e000233
Author(s):  
Jorge Espinel-Rupérez ◽  
Maria Dolores Martín-Ríos ◽  
Veronica Salazar ◽  
Maria Rosario Baquero-Artigao ◽  
Gustavo Ortiz-Díez
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Surgical Site Infection ◽  
Economic Impact ◽  
Teaching Hospital ◽  
Primary Outcome Measure ◽  
Site Infection ◽  
Urinary Catheterisation ◽  
Organ Space Infection ◽  
Soft Tissue Surgery

ObjectivesTo determine (1) the incidence of surgical site infection (SSI) in patients undergoing soft tissue surgery at a veterinary teaching hospital and to study (2) and describe the main risk factors associated with SSI and (3) assess the economic impact of SSI.DesignProspective cohort study.SettingVeterinary teaching hospital.Participants184 dogs undergoing soft tissue surgery during a 12-month period (October 2013 to September 2014).Primary outcome measureSurgical site infection.ResultsOut of the 184 patients analysed, SSI was diagnosed in 16 (8.7 per cent) patients, 13 (81.3 per cent) were classified as superficial incisional infection, 2 (12.5 per cent) as deep incisional infection and 1 (6.3 per cent) as organ/space infection. The administration of steroidal anti-inflammatory drugs (P=0.028), preoperative hyperglycaemia (P=0.015), surgical times longer than 60 minutes (P=0.013), urinary catheterisation (P=0.037) and wrong use of the Elizabethan collar (P=0.025) were identified as risk factors. Total costs increased 74.4 per cent, with an increase in postsurgical costs of 142.2 per cent.ConclusionsThe incidence of SSI was higher than the incidence reported in other published studies, although they were within expected ranges when a surveillance system was implemented. This incidence correlated with an increase in costs. Additionally new important risk factors for its development were detected.

58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Mistry ◽  
B Woolner ◽  
A John
Keyword(s):  
Surgical Site Infection ◽  
Open Cholecystectomy ◽  
Surgical Site Infections ◽  
Standard Operating Procedure ◽  
Site Infection ◽  
Infection Rates ◽  
Local Evidence ◽  
Audit Data ◽  
The Impact ◽  
To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

scholarly journals Standardising intraoperative irrigation with 0.05% chlorhexidine gluconate in caesarean delivery to reduce surgical site infections: A single institution experience

2019 ◽  
Vol 30 (1-2) ◽  
pp. 24-33
Author(s):  
Theresa Mangold ◽  
Erin Kinzel Hamilton ◽  
Helen Boehm Johnson ◽  
Rene Perez
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Caesarean Delivery ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Antibiotic Administration ◽  
Site Infection ◽  
Infection Rates ◽  
The Impact

Background Surgical site infection is a significant cause of morbidity and mortality following caesarean delivery. Objective To determine whether standardising intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery could decrease infection rates. Methods This was a process improvement project involving 742 women, 343 of whom received low-pressured 0.05% chlorhexidine gluconate irrigation during caesarean delivery over a one-year period. Infection rates were compared with a standard-of-care control group (399 women) undergoing caesarean delivery the preceding year. Results The treatment group infection rate met the study goal by achieving a lower infection rate than the control group, though this was not statistically significant. A significant interaction effect between irrigation with 0.05% chlorhexidine gluconate and antibiotic administration time existed, such that infection occurrence in the treatment group was not dependent on antibiotic timing, as opposed to the control group infection occurrence, which was dependent on antibiotic timing. Conclusion Intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery did not statistically significantly reduce the rate of infections. It did render the impact of antibiotic administration timing irrelevant in prevention of surgical site infection. This suggests a role for 0.05% chlorhexidine gluconate irrigation in mitigating infection risk whether antibiotic prophylaxis timing is suboptimal or ideal.

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