scholarly journals Povidone-iodine-alcohol is superior to chlorhexidine-alcohol in its antimicrobial efficacy on the anaerobic microbial flora in surgical skin preparation of the shoulder region

2019 ◽  
Author(s):  
Dorothea Dörfel ◽  
Georg Daeschlein ◽  
Matthias Maiwald ◽  
Gerald Müller ◽  
Robert Hudek ◽  
...  
Keyword(s):  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Shoulder Surgery ◽  
Skin Microbiome ◽  
Negative Effects ◽  
Skin Preparation ◽  
Prolonged Contact ◽  
Skin Flora ◽  
Cutibacterium Acnes ◽  
Skin Antisepsis

Abstract Background: Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an important agent of surgical site infections (SSI), particularly in shoulder surgery, and is difficult to target with skin antisepsis. We hypothesized that prolonged preparation with an agent that penetrates deeper into the skin is more effective in shoulder surgery. Thus, we compared two different classes of antiseptics, each combined with alcohol, and each applied with two different contact times. Methods: Shoulders of 16 healthy volunteers were treated for 2.5 min (standard) or 30 min (prolonged) with alcohol-based chlorhexidine (CHG-ALC; 2% w/v CHG, 55% w/v [70% v/v] 2-propanol) or alcohol-based povidone iodine (PVP-I-ALC; 3.24% w/v PVP-I, 38.9% w/v 2-propanol, 37.3% w/v ethanol). Skin sites were sampled before, immediately after, and 3 h after treatment. Results: Aerobic skin flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after 2.5 min and immediate sampling, but not after prolonged contact times and 3-h sampling. Anaerobic flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after standard and prolonged contact times and immediate sampling, but not after 3-h sampling. None of the volunteers reported negative effects from skin antisepsis. Conclusions: PVP-I-ALC is more efficacious than CHG-ALC for topical skin antisepsis regarding the anaerobic flora on the skin of the shoulder. Standard and prolonged contact times demonstrated superiority for PVP-I-ALC for samples taken immediately, but missed significance 3 h after application. The clinical relevance of these findings should be studied with SSI as an endpoint.

scholarly journals Povidone-iodine-alcohol is superior to chlorhexidine-alcohol in its antimicrobial efficacy on the anaerobic microbial flora in surgical skin preparation of the shoulder Region

2020 ◽  
Author(s):  
Dorothea Dörfel ◽  
Georg Daeschlein ◽  
Matthias Maiwald ◽  
Gerald Müller ◽  
Robert Hudek ◽  
...  
Keyword(s):  
Povidone Iodine ◽  
Shoulder Surgery ◽  
Skin Microbiome ◽  
Coagulase Negative Staphylococci ◽  
Skin Preparation ◽  
Prolonged Contact ◽  
Skin Flora ◽  
Significant Difference ◽  
Cutibacterium Acnes ◽  
Skin Antisepsis

Abstract Background Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery and is difficult to target with skin antisepsis. We hypothesized that prolonged preparation with an agent that penetrates more deeply into the skin is more effective in shoulder surgery. Thus, we compared two different classes of antiseptics, each combined with alcohol, and each applied with two different contact times. Methods Using a cross-over study design, shoulders of 16 healthy volunteers were treated for 2.5 min (standard) or 30 min (prolonged) with alcohol-based chlorhexidine (CHG-ALC; 2% w/v CHG, 55% w/v [70% v/v] 2-propanol) or alcohol-based povidone-iodine (PVP-I-ALC; 3.24% w/v PVP-I, 38.9% w/v 2-propanol, 37.3% w/v ethanol). Skin sites were sampled before, immediately after, and 3 h after treatment, using a standardized cup-scrub technique. Results Aerobic skin flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after 2.5 min application and immediate sampling (reduction factor [RF] 2.55±0.75 vs. 1.94±0.91, p = 0.04), but not after prolonged contact times and 3-h sampling. Coagulase-negative staphylococci were completely eliminated after PVP-I-ALC application, but still recovered from 3 of 16 and 1 of 16 samples after 2.5-min and 30-min CHG-ALC application and immediate sampling, respectively. Anaerobic flora, mostly consisting of C. acnes, was reduced more effectively by PVP-I-ALC than by CHG-ALC after standard (RF 3.96±1.46 vs. 1.74±1.24, p < 0.01) and prolonged (RF 3.14±1.20 vs. 1.38±1.16, p < 0.01) contact times. Sampling 3 h after treatment did not show any significant difference. None of the volunteers reported adverse events. Conclusions PVP-I-ALC is more efficacious than CHG-ALC for topical skin antisepsis concerning the anaerobic flora on the skin of the shoulder. Standard and prolonged contact times demonstrated superiority for PVP-I-ALC for samples taken immediately, but missed significance 3 h after application. The results underscore the need for protection against C. acnes and coagulase-negative staphylococci in orthopaedic surgery and the need to prevent infections caused by these organisms. The clinical relevance of these findings, however, should be studied with SSI as an endpoint.

scholarly journals Comparison of the antimicrobial efficacy of povidone-iodine-alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic skin flora of the shoulder region

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Dorothea Dörfel ◽  
Matthias Maiwald ◽  
Georg Daeschlein ◽  
Gerald Müller ◽  
Robert Hudek ◽  
...  
Keyword(s):  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Reduction Factor ◽  
Skin Microbiome ◽  
Coagulase Negative Staphylococci ◽  
Skin Preparation ◽  
Prolonged Contact ◽  
Skin Flora ◽  
Cutibacterium Acnes ◽  
Shoulder Region

Abstract Background Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery. We hypothesized that prolonged skin preparation with an agent that penetrates deeply into the skin would be beneficial. Thus, we compared two classes of antiseptics, each combined with alcohol, each applied with two different contact times. Methods Using a cross-over arrangement, shoulders of 16 healthy volunteers were treated for 2.5 min (standard) or 30 min (prolonged) with alcohol-based chlorhexidine (CHG-ALC) or alcohol-based povidone-iodine (PVP-I-ALC). Skin sites were sampled before, immediately after, and 3 h after treatment, using a standardized cup-scrub technique. Results Aerobic skin flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after 2.5 min application and immediate sampling (reduction factor [RF] 2.55 ± 0.75 vs. 1.94 ± 0.91, p = 0.04), but not after prolonged contact times and 3-h sampling. Coagulase-negative staphylococci were completely eliminated after PVP-I-ALC application, but still recovered from 4 of 32 samples after CHG-ALC application. Anaerobic flora was reduced more effectively by PVP-I-ALC than CHG-ALC after standard (RF 3.96 ± 1.46 vs. 1.74 ± 1.24, p < 0.01) and prolonged (RF 3.14 ± 1.20 vs. 1.38 ± 1.16, p < 0.01) contact times and immediate sampling, but not after 3-h sampling. No adverse events were reported. Conclusions PVP-I-ALC showed marginal benefits concerning the aerobic flora, but more substantial benefits over CHG-ALC concerning the anaerobic flora of the shoulder. Standard and prolonged contact times showed superiority for PVP-I-ALC for anaerobic flora at all immediate sampling points, but missed significance at 3-h sampling. The results underscore the need for protection against C. acnes and coagulase-negative staphylococci in orthopaedic surgery. The clinical relevance of these findings, however, should be studied with SSI as an endpoint.

scholarly journals Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mario Mastrocola ◽  
Georg Matziolis ◽  
Sabrina Böhle ◽  
Chris Lindemann ◽  
Peter Schlattmann ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Povidone Iodine ◽  
Meta Analysis ◽  
Bacterial Flora ◽  
Positive Culture ◽  
Surgical Site Infections ◽  
Skin Preparation ◽  
Skin Flora ◽  
Skin Colonization ◽  
Normal Bacterial Flora

AbstractPreoperative skin preparation is an effective method to prevent surgical site infections (SSI). Alcoholic chlorhexidine (CHG) and povidone iodine (PV-I) are the most widely used antiseptic agents. This meta-analysis aims to determine their efficacy in reducing natural bacterial skin flora in clean orthopedic surgery. A systematic search was conducted through current literature up to June 2021 to identify clinical randomized trials that compared the efficacy of alcoholic chlorhexidine and povidone iodine in reducing bacterial skin colonization after preoperative skin preparation. A meta-analysis was conducted. Of 235 screened articles, 8 randomized controlled trials were included. The results of the meta-analysis demonstrate a significantly lower positive culture rate in the chlorhexidine group than in the povidone iodine group (RR = 0.53, 95% Cl: 0.32–0.88). The present data show the superiority of chlorhexidine in reducing the normal bacterial flora compared to povidone iodine in clean orthopedic surgery.

Evaluation of the effectiveness of skin preparation methods for the reduction of Cutibacterium acnes (formerly Propionibacterium acnes) in shoulder surgery: a systematic review

2021 ◽  
pp. 175857322110325
Author(s):  
Maria Sagkrioti ◽  
Stephen Glass ◽  
Georgios Arealis
Keyword(s):  
Systematic Review ◽  
Hydrogen Peroxide ◽  
Side Effects ◽  
Cost Effective ◽  
Shoulder Surgery ◽  
Skin Preparation ◽  
Preparation Methods ◽  
Cutibacterium Acnes ◽  
Surgery Outcomes ◽  
Positive Effect

Background Cutibacterium acnes ( C. acnes) is the most common pathogen responsible for post-operative shoulder infections. The purpose of this study was to evaluate the effectiveness of skin preparation methods against C. acnes in shoulder surgery. Methods A systematic review was conducted evaluating the effectiveness of skin preparation methods in the reduction of C. acnes in patients undergoing shoulder surgery. Outcomes were assessed based on the effectiveness of the method used; side effects and cost were also analysed. Results Of the 19 included studies, 9 evaluated pre-surgical home treatments: 8 assessed benzoyl peroxide (BPO) and 6 concluded it is effective in reducing C. acnes. Nine studies assessed surgical skin preparation and concluded that Chlorhexidine gluconate (CHG) was not effective; in contrast hydrogen peroxide reduced C. acnes. Finally, one study evaluated an aseptic protocol using CHG and concluded that it was not effective. Conclusions It was demonstrated that BPO as home treatment is effective in reducing C. acnes load on skin ; it rarely causes side effects and is also cost-effective. This study highlights non-effectiveness of CHG. There was some evidence that the addition of hydrogen peroxide could have a positive effect in the reduction of C. acnes skin load; however, more studies are required.

The management of the shoulder skin microbiome (Cutibacterium acnes) in the context of shoulder surgery: a review of the current literature

2020 ◽  
pp. 175857322094522
Author(s):  
Nathan FE Moore ◽  
Timothy J Batten ◽  
Christopher EJ Hutton ◽  
William James White ◽  
Christopher D Smith
Keyword(s):  
Current Literature ◽  
Current Knowledge ◽  
Joint Infection ◽  
Bacterial Load ◽  
Skin Microbiome ◽  
Skin Preparation ◽  
Joint Infections ◽  
Cutibacterium Acnes ◽  
Skin Contamination ◽  
True Infection

Background This review aims to establish current knowledge of the shoulder skin microbiome and how to manage the bacteria that reside within it. Methods A review was undertaken of the current literature through OvidSP. All abstracts were reviewed by three independent researchers. Results Thirty-five studies met the inclusion criteria. With forward referencing an additional 14 were included. None commented on organisms specific to the shoulder microbiome other than Cutibacterium acnes. Therefore, this review is focussed on the current knowledge of C. acnes. Discussion C. acnes is a skin commensal within the pilo-sebaceous glands reported to be the primary pathogen in up to 86% of shoulder joint infections. Pre-operative culture of unprepared skin can be indicative of underlying joint infection in shoulder arthroplasty revision. Intra-articular biopsies may have a high false positive due to skin contamination. Correlating the number of positive samples and certain associated signs can give a greater than 90% probability of a true infection. Standard surgical skin preparation, peri-surgical intravenous antibiotics and oral pre-operative antibiotics do not reduce bacterial load within the skin. However, topical benzoyl peroxide and clindamycin have both demonstrated significantly reduced bacteria load. Phylogenetically there are six main types. Patients may have more than one phenotype present during infection.

scholarly journals Antiseptic efficacy of an innovative perioperative surgical skin preparation: A confirmatory FDA phase 3 analysis

2020 ◽  
Vol 41 (6) ◽  
pp. 653-659
Author(s):  
Charles E. Edmiston ◽  
Philip Lavin ◽  
Maureen Spencer ◽  
Gwen Borlaug ◽  
Gary R. Seabrook ◽  
...  
Keyword(s):  
Skin Irritation ◽  
Phase 3 ◽  
Skin Preparation ◽  
Time Points ◽  
Efficacy Analysis ◽  
Colony Forming Units ◽  
Human Volunteers ◽  
Skin Flora ◽  
Skin Antisepsis ◽  
Antiseptic Agent

AbstractBackground:An innovative approach to perioperative antiseptic skin preparation is warranted because of potential adverse skin irritation, rare risk of serious allergic reaction, and perceived diminished clinical efficacy of current perioperative antiseptic agents. The results of a confirmatory US Food and Drug Administration (FDA) phase 3 efficacy analysis of a recently approved innovative perioperative surgical skin antiseptic agent are discussed.Methods:The microbial skin flora on abdominal and groin sites in healthy volunteers were microbiologically sampled following randomization to either ZuraGard, a 2% chlorhexidine/70% isopropyl alcohol preparation (Chloraprep), or a control vehicle (alcohol-free ZuraGard). Mean log10 reduction of colony-forming units (CFU) was assessed at 30 seconds, 10 minutes, and 6 hours.Results:For combined groin sites (1,721 paired observations) at all time points, the mean log10 CFU reductions were significantly greater in the ZuraGard group than in the Chloraprep group (P < .02). Mean log10 CFU reductions across combined abdominal and groin sites at all time points (3,277 paired observations) were significantly greater in the ZuraGard group than in the Chloraprep group (P < .02).Conclusions:A confirmatory FDA phase 3 efficacy analysis of skin antisepsis in human volunteers documented that ZuraGard was efficacious in significantly reducing the microbial burden on abdominal and groin test sites, exceeding that of Chloraprep. No significant adverse reactions were observed following the application of ZuraGard.Trial registration:ClinicalTrials.gov identifiers: NCT02831998 and NCT02831816.

scholarly journals Does Skin Preparation Influence Surgical Site Infection in Laparotomy Wounds: Comparative Evaluation of Preoperative Skin Preparation With 4% Chlorhexidine With 5% Povidone Iodine in Laparotomy Wounds: A Prospective Trial

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Ravindran Chirukandath ◽  
Manoj P. Elangovan ◽  
Agil B. ◽  
Reshma A. Cheedhamadathil ◽  
Ayana M. Dev ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Prospective Trial ◽  
Surgical Site Infections ◽  
P Value ◽  
Site Infection ◽  
Related Complication ◽  
Skin Preparation ◽  
Emergency Procedures ◽  
Significant Difference

Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109,  5% Povidone iodine prepared patients undergoing various elective n = 114 and emergency procedures n = 123. The overall SSI rates in 7 days in the whole group were 13.44 %. The SSI rates on the 4% Chlorhexidine group were 10.16% and 5% povidone iodine group were 17.27% and it was statically significant with a p value of p = 0.00413 showing significant reduction in the 4% Chlorhexidine group. The study also compared the SSI rates in elective and emergency procedures in both groups with significant difference in emergency procedures. More variables are also compared between the groups and results were analyzed. Conclusion: This study shows the use of Chlorhexidine 4% reduces the morbidity of one of the most common wound related complication in laparotomy patients in all categories of laparotomy wounds.

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