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 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 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.

Chlorhexidine–Alcohol Compared with Povidone–Iodine Preoperative Skin Antisepsis for Cesarean Delivery: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 36 (02) ◽  
pp. 118-123 ◽  
Author(s):  
Megan Whitham ◽  
Sherif El-Nashar ◽  
Steven Clark ◽  
Mary Tolcher
Keyword(s):  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Povidone Iodine ◽  
Meta Analysis ◽  
Site Infection ◽  
Superficial Infection ◽  
Skin Preparation ◽  
Statistical Heterogeneity ◽  
Significant Difference ◽  
Skin Antisepsis

Objective To compare chlorhexidine–alcohol with povidone–iodine solutions for skin antisepsis prior to cesarean delivery for the prevention of surgical site infection. Study Design Electronic databases MEDLINE, Embase, Scopus, and Clinicaltrials.gov were searched from inception to August 2017. Eligible studies included randomized controlled trials comparing chlorhexidine–alcohol with povidone–iodine skin preparation solutions for women undergoing cesarean delivery. The primary outcome was surgical site infection including superficial or deep wound infection. Meta-analysis was performed, and risk ratios (RRs) with 95% confidence interval (CI) were calculated using the Mantel–Haenszel random effects model. Statistical heterogeneity was assessed using Higgin's I 2. Results Of 61 abstracts identified in the primary search, four studies (3,059 women) met the eligibility criteria. The risk of surgical site infection was significantly reduced with chlorhexidine–alcohol (RR: 0.72; 95% CI: 0.52–0.98). No heterogeneity across studies was observed with I 2 = 0%. Subgroup analysis of superficial infection only or deep infection only showed no statistically significant difference (RR: 0.76, 95% CI: 0.54–1.08; and RR: 0.50, 95% CI: 0.23–1.10, respectively). Conclusion Preoperative skin cleansing prior to cesarean delivery with chlorhexidine–alcohol reduces surgical site infection as compared with povidone–iodine solutions.

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.

scholarly journals Single versus Double Skin Preparation for Infection Prevention in Proximal Humeral Fracture Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Davide Blonna ◽  
Valeria Allizond ◽  
Enrico Bellato ◽  
Giuliana Banche ◽  
Anna Maria Cuffini ◽  
...  
Keyword(s):  
Proximal Humeral Fracture ◽  
Povidone Iodine ◽  
Bacterial Load ◽  
Positive Culture ◽  
Humeral Fracture ◽  
Microbiological Analysis ◽  
Coagulase Negative Staphylococci ◽  
Skin Preparation ◽  
Double Skin ◽  
Deltopectoral Approach

Preoperative skin preparation plays a major role in preventing postoperative infections. This study aims to compare a single skin preparation (povidone iodine) with a double skin preparation (chlorhexidine gluconate followed by povidone iodine). Forty patients affected by proximal humeral fracture were included in the study. The day of surgery the two skin preparation strategies were performed in the same shoulder, divided into two areas, at the level of the deltopectoral approach. Skin swabs were collected from each area and subjected to microbiological analysis. Both skin preparations significantly reduced the positive culture rate. Coagulase-negative staphylococci (CoNS) dropped from 92.5% to 40% and to 7.5% after the single and double skin preparation (p<0.001), respectively. The positivity rate was reduced from 50% to 17.5% (p=0.002) and from 27.5% to 0% (p= 0.001) for Propionibacterium acnes and Staphylococcus aureus, respectively, with no difference between the two preparations. The double skin preparation had a more significant effect on bacterial load against CoNS compared to the single skin preparation (p<0.001 versus p= 0.015). In conclusion, both the approaches reduced S. aureus and P. acnes skin load, whereas the double skin preparation is more effective than the single one against CoNS. In light of our findings, preoperative strategies able to reduce bacterial load could potentially increase the final efficacy of perioperative traditional skin preparations.

scholarly journals Back to Basics: Could the Preoperative Skin Antiseptic Agent Help Prevent Biofilm-Related Capsular Contracture?

2018 ◽  
Vol 39 (8) ◽  
pp. 848-859 ◽  
Author(s):  
Jenny Carvajal ◽  
Melissa Carvajal ◽  
Gilma Hernández
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Bacterial Biofilm ◽  
Skin Microbiome ◽  
Level Of Evidence ◽  
Clinical Safety ◽  
Skin Preparation ◽  
Significant Difference ◽  
Chi Squared ◽  
Healthcare Epidemiology

AbstractBackgroundCapsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC.ObjectivesThe authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach.MethodsIn June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients.ResultsPearson’s chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed.ConclusionsCHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.Level of Evidence: 3

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 In vitro activity of tea-tree oil against clinical skin isolates of meticillin-resistant and -sensitive Staphylococcus aureus and coagulase-negative staphylococci growing planktonically and as biofilms

2006 ◽  
Vol 55 (10) ◽  
pp. 1375-1380 ◽  
Author(s):  
Aaron Brady ◽  
Ryan Loughlin ◽  
Deirdre Gilpin ◽  
Paddy Kearney ◽  
Michael Tunney
Keyword(s):  
Staphylococcus Aureus ◽  
Bactericidal Activity ◽  
Viable Count ◽  
Tea Tree Oil ◽  
Coagulase Negative Staphylococci ◽  
Tea Tree ◽  
Skin Flora ◽  
Significant Difference ◽  
Time Kill

The susceptibility of Staphylococcus aureus [meticillin-resistant (MRSA) and meticillin-sensitive (MSSA)] and coagulase-negative staphylococci (CoNS), which respectively form part of the transient and commensal skin flora, to tea-tree oil (TTO) was compared using broth microdilution and quantitative in vitro time–kill test methods. MRSA and MSSA isolates were significantly less susceptible than CoNS isolates, as measured by both MIC and minimum bactericidal concentration. A significant decrease in the mean viable count of all isolates in comparison with the control was seen at each time interval in time–kill assays. However, the only significant difference in the overall mean log10 reduction in viable count between the groups of isolates was between CoNS and MSSA at 3 h, with CoNS isolates demonstrating a significantly lower mean reduction. To provide a better simulation of in vivo conditions on the skin, where bacteria are reported to grow as microcolonies encased in glycocalyx, the bactericidal activity of TTO against isolates grown as biofilms was also compared. Biofilms formed by MSSA and MRSA isolates were completely eradicated following exposure to 5 % TTO for 1 h. In contrast, of the biofilms formed by the nine CoNS isolates tested, only five were completely killed, although a reduction in viable count was apparent for the other four isolates. These results suggest that TTO exerts a greater bactericidal activity against biofilm-grown MRSA and MSSA isolates than against some biofilm-grown CoNS isolates.

scholarly journals Preoperative skin antisepsis with chlorhexidine gluconate versus povidone-iodine: a prospective analysis of 6959 consecutive spinal surgery patients

2018 ◽  
Vol 28 (2) ◽  
pp. 209-214 ◽  
Author(s):  
George M. Ghobrial ◽  
Michael Y. Wang ◽  
Barth A. Green ◽  
Howard B. Levene ◽  
Glen Manzano ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Open Surgery ◽  
Isopropyl Alcohol ◽  
Povidone Iodine ◽  
Chlorhexidine Gluconate ◽  
Iodine Solution ◽  
Significant Difference ◽  
Skin Antisepsis ◽  
Consecutive Time ◽  
Povidone Iodine Solution

OBJECTIVEThe aim of this study was to determine the efficacy of 2 common preoperative surgical skin antiseptic agents, ChloraPrep and Betadine, in the reduction of postoperative surgical site infection (SSI) in spinal surgery procedures.METHODSTwo preoperative surgical skin antiseptic agents—ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol) and Betadine (7.5% povidone-iodine solution)—were prospectively compared across 2 consecutive time periods for all consecutive adult neurosurgical spine patients. The primary end point was the incidence of SSI.RESULTSA total of 6959 consecutive spinal surgery patients were identified from July 1, 2011, through August 31, 2015, with 4495 (64.6%) and 2464 (35.4%) patients treated at facilities 1 and 2, respectively. Sixty-nine (0.992%) SSIs were observed. There was no significant difference in the incidence of infection between patients prepared with Betadine (33 [1.036%] of 3185) and those prepared with ChloraPrep (36 [0.954%] of 3774; p = 0.728). Neither was there a significant difference in the incidence of infection in the patients treated at facility 1 (52 [1.157%] of 4495) versus facility 2 (17 [0.690%] of 2464; p = 0.06). Among the patients with SSI, the most common indication was degenerative disease (48 [69.6%] of 69). Fifty-one (74%) patients with SSI had undergone instrumented fusions in the index operation, and 38 (55%) patients with SSI had undergone revision surgeries. The incidence of SSI for minimally invasive and open surgery was 0.226% (2 of 885 cases) and 1.103% (67 of 6074 cases), respectively.CONCLUSIONSThe choice of either ChloraPrep or Betadine for preoperative skin antisepsis in spinal surgery had no significant impact on the incidence of postoperative SSI.

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