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Infect Control Hosp Epidemiol. 2009 Oct;30(10):964-71. doi: 10.1086/605926.

Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols.

Author information

1
Departments of Surgery, University of Virginia Health System, Charlottesville, 22908-0300, USA. brs3j@virginia.edu

Abstract

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.

PMID:
19732018
PMCID:
PMC3371364
DOI:
10.1086/605926
[Indexed for MEDLINE]
Free PMC Article

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