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

Published online by Cambridge University Press:  02 January 2015

Brian R. Swenson ,
Traci L. Hedrick ,
Rosemarie Metzger ,
Hugo Bonatti ,
Timothy L. Pruett  and
Robert G. Sawyer
Brian R. Swenson*
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Traci L. Hedrick
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Rosemarie Metzger
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Hugo Bonatti
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Timothy L. Pruett
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville
Robert G. Sawyer
Affiliation:
Departments of Surgery, University of Virginia Health System, Charlottesville Public Health Sciences, University of Virginia Health System, Charlottesville
*
Department of Surgery, University of Virginia Health System, PO Box 800300, Charlottesville, VA 22908-0300 (brs3j@virginia.edu)
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 10 , October 2009 , pp. 964 - 971
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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