Measures for the Prevention of Surgical Site Infection

Summary

Among the causes associated with infection of hospitalized patients, surgical site infection is a complication that is potentially associated with any type of surgical procedure, it also represents an expressive burden in terms of morbidity and mortality, as well as additional costs for health care systems around the world. It is regarded that the efficiency of the pre, per, and postoperative skin preparation depends on both the adopted antiseptic and the application method, with Chlorhexidine currently being the most used drug in such preparation. However, the manner, timing, or timing of cutaneous antisepsis action is unclear. Objective: Comparing antisepsis techniques using chlorhexidine-based soap associated with ethyl alcohol and alcoholic chlorhexidine versus chlorhexidine-based soap associated with alcoholic chlorhexidine, in surgical orthopedic procedures.

Timeline

Start

2017-06-30

Primary completion

2017-11-07

Completion

2017-11-07

Publications

• Background Bohl DD, Ondeck NT, Darrith B, Hannon CP, Fillingham YA, Della Valle CJ. Impact of Operative Time on Adverse Events Following Primary Total Joint Arthroplasty. J Arthroplasty. 2018 Jul;33(7):2256-2262.e4. doi: 10.1016/j.arth.2018.02.037. Epub 2018 Feb 17.
• Background Capen DA, Calderone RR, Green A. Perioperative risk factors for wound infections after lower back fusions. Orthop Clin North Am. 1996 Jan;27(1):83-6.
• Background Charles D, Heal CF, Delpachitra M, Wohlfahrt M, Kimber D, Sullivan J, Browning S, Saednia S, Hardy A, Banks J, Buttner P. Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial. CMAJ. 2017 Aug 8;189(31):E1008-E1016. doi: 10.1503/cmaj.161460.
• Background Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt). 2017 Aug/Sep;18(6):722-735. doi: 10.1089/sur.2017.089.
• Background Dicks KV, Baker AW, Durkin MJ, Anderson DJ, Moehring RW, Chen LF, Sexton DJ, Weber DJ, Lewis SS. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures. Infect Control Hosp Epidemiol. 2015 Dec;36(12):1431-6. doi: 10.1017/ice.2015.222. Epub 2015 Sep 22.
• Background Drakos MC, Murphy CI. Bracing versus casting in ankle fractures. Phys Sportsmed. 2014 Nov;42(4):60-70. doi: 10.3810/psm.2014.11.2092.
• Background Duchman KR, Pugely AJ, Martin CT, Gao Y, Bedard NA, Callaghan JJ. Operative Time Affects Short-Term Complications in Total Joint Arthroplasty. J Arthroplasty. 2017 Apr;32(4):1285-1291. doi: 10.1016/j.arth.2016.12.003. Epub 2016 Dec 14.
• Background Ellenhorn JD, Smith DD, Schwarz RE, Kawachi MH, Wilson TG, McGonigle KF, Wagman LD, Paz IB. Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites. J Am Coll Surg. 2005 Nov;201(5):737-41. doi: 10.1016/j.jamcollsurg.2005.05.023. Epub 2005 Aug 31.
• Background George J, Klika AK, Higuera CA. Use of Chlorhexidine Preparations in Total Joint Arthroplasty. J Bone Jt Infect. 2017 Jan 1;2(1):15-22. doi: 10.7150/jbji.16934. eCollection 2017.
• Background Glassman SD, Dimar JR, Puno RM, Johnson JR. Salvage of instrumental lumbar fusions complicated by surgical wound infection. Spine (Phila Pa 1976). 1996 Sep 15;21(18):2163-9. doi: 10.1097/00007632-199609150-00021.
• Background Hosseini P, Mundis GM Jr, Eastlack R, Nourian A, Pawelek J, Nguyen S, Akbarnia BA. Do Longer Surgical Procedures Result in Greater Contamination of Surgeons' Hands? Clin Orthop Relat Res. 2016 Jul;474(7):1707-13. doi: 10.1007/s11999-016-4832-1. Epub 2016 Apr 18.
• Background Houang ET, Buckley R, Smith M, O'Riordan SM. Survival of Pseudomonas aeruginosa in plaster of Paris. J Hosp Infect. 1981 Sep;2(3):231-5. doi: 10.1016/0195-6701(81)90042-6. No abstract available.
• Background Kamel C, McGahan L, Mierzwinski-Urban M, Embil J. Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections: A Systematic Review of the Clinical Evidence and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2011 Jun. Available from http://www.ncbi.nlm.nih.gov/books/NBK174549/
• Background Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol. 2010 Dec;31(12):1219-29. doi: 10.1086/657134. Epub 2010 Oct 22.
• Background Levi AD, Dickman CA, Sonntag VK. Management of postoperative infections after spinal instrumentation. J Neurosurg. 1997 Jun;86(6):975-80. doi: 10.3171/jns.1997.86.6.0975.
• Background Martinez J, Macias JH, Arreguin V, Alvarez JA, Macias AE, Mosqueda-Gomez JL. Isopropyl alcohol is as efficient as chlorhexidine to prevent contamination of blood cultures. Am J Infect Control. 2017 Apr 1;45(4):350-353. doi: 10.1016/j.ajic.2016.11.027. Epub 2017 Jan 12.
• Background Mears SC, Dinah AF, Knight TA, Frassica FJ, Belkoff SM. Visibility of surgical site marking after preoperative skin preparation. Eplasty. 2008 Jul 16;8:e35.
• Background Ovaska MT, Makinen TJ, Madanat R, Huotari K, Vahlberg T, Hirvensalo E, Lindahl J. Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am. 2013 Feb 20;95(4):348-53. doi: 10.2106/JBJS.K.01672.
• Background Peel TN, Cheng AC, Buising KL, Dowsey MM, Choong PF. Alcoholic Chlorhexidine or Alcoholic Iodine Skin Antisepsis (ACAISA): protocol for cluster randomised controlled trial of surgical skin preparation for the prevention of superficial wound complications in prosthetic hip and knee replacement surgery. BMJ Open. 2014 May 15;4(5):e005424. doi: 10.1136/bmjopen-2014-005424.
• Background Prottey C, Pryce NG. Hand cleansing and skin condition. A comparison of conventional soap washing and the use of alcohol-impregnated paper cloths. Int J Cosmet Sci. 1987 Apr;9(2):53-8. doi: 10.1111/j.1467-2494.1987.tb00462.x.
• Background Reichel M, Heisig P, Kohlmann T, Kampf G. Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob Agents Chemother. 2009 Nov;53(11):4778-82. doi: 10.1128/AAC.00582-09. Epub 2009 Sep 8.
• Background Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br. 2005 Jun;87(6):844-50. doi: 10.1302/0301-620X.87B6.15121.
• Background Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res. 1986 Feb;(203):7-17.
• Background Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am. 2009 Aug;91(8):1949-53. doi: 10.2106/JBJS.H.00768.
• Background Savage JW, Anderson PA. An update on modifiable factors to reduce the risk of surgical site infections. Spine J. 2013 Sep;13(9):1017-29. doi: 10.1016/j.spinee.2013.03.051. Epub 2013 May 24.
• Background Schepers T, De Vries MR, Van Lieshout EM, Van der Elst M. The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature. Int Orthop. 2013 Mar;37(3):489-94. doi: 10.1007/s00264-012-1753-9. Epub 2013 Jan 4.
• Background Segal CG, Anderson JJ. Preoperative skin preparation of cardiac patients. AORN J. 2002 Nov;76(5):821-8. doi: 10.1016/s0001-2092(06)61035-1.
• Background Veiga DF, Damasceno CAV, Veiga-Filho J, Figueiras RG, Vieira RB, Florenzano FH, Juliano Y, Ferreira LM. Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. Plast Reconstr Surg. 2008 Nov;122(5):170e-171e. doi: 10.1097/PRS.0b013e318186cd7f. No abstract available.
• Background Vioreanu M, Dudeney S, Hurson B, Kelly E, O'Rourke K, Quinlan W. Early mobilization in a removable cast compared with immobilization in a cast after operative treatment of ankle fractures: a prospective randomized study. Foot Ankle Int. 2007 Jan;28(1):13-9. doi: 10.3113/FAI.2007.0003.
• Background Weed S, Bastek JA, Sammel MD, Beshara M, Hoffman S, Srinivas SK. Comparing postcesarean infectious complication rates using two different skin preparations. Obstet Gynecol. 2011 May;117(5):1123-1129. doi: 10.1097/AOG.0b013e3182118e98.

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Indications