Antisepsis of the skin before spinal surgery with povidone iodine alcohol followed by chlorhexidine gluconate-alcohol versus povidone iodine-alcohol applied twice for the prevention of contamination of the wound by bacteria: a randomised controlled trial.

Sheila Patrick, Andrew McDowell, Andrew Lee, Alessandra Frau, Una Martin, Evie Gardiner, Gregory McLorinan, Niall Eames

Research output: Contribution to journalArticle

Abstract

Aims:To determine if sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in spinal surgery patients. Patients and Methods: A single-centre, interventional, two arm, parallel group randomised controlled trial of 407 patients attending hospital for elective spinal surgery was conducted. For 203 patients, pre-surgical skin disinfection was by application of PVI (10% [w/w (1% w/w available iodine)] povidone iodine in 95% industrial denatured alcohol; Videne Alcoholic Tincture) twice and for 204 patients application of PVI once followed by application of CHG (2% [w/v] chlorhexadine gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint). The primary outcome measure was post-skindisinfection surgical site contamination determined by aerobic and anaerobicbacterial growth from post-skin disinfection samples. Results: The detection of viable bacteria in any one of the post-skin disinfection samples (culture-positive) was significantly lower in the group treated with both PVI and CHG than in the group treated with PVI alone: 29.1% (59) vs 41.7% (85), P=0.009; relative risk, 0.574; 95% confidence interval, 0.380 to 0.866. Conclusions: Skin antisepsis with sequential application of PVI and CHG more effectively reduces surgical wound contamination than PVI alone.
LanguageEnglish
Pages1354-1365
Number of pages11
JournalBone and Joint Journal
Volume99-B
Early online date1 Oct 2017
Publication statusE-pub ahead of print - 1 Oct 2017

Fingerprint

Antisepsis
Povidone-Iodine
Randomized Controlled Trials
Alcohols
Bacteria
Skin
Wounds and Injuries
Disinfection
chlorhexidine gluconate
2-Propanol
Iodine

Keywords

  • Skin
  • surgery
  • wound
  • contamination
  • antiseptics
  • povidone iodine-alcohol
  • chlorhexidine gluconate-alcohol

Cite this

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title = "Antisepsis of the skin before spinal surgery with povidone iodine alcohol followed by chlorhexidine gluconate-alcohol versus povidone iodine-alcohol applied twice for the prevention of contamination of the wound by bacteria: a randomised controlled trial.",
abstract = "Aims:To determine if sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in spinal surgery patients. Patients and Methods: A single-centre, interventional, two arm, parallel group randomised controlled trial of 407 patients attending hospital for elective spinal surgery was conducted. For 203 patients, pre-surgical skin disinfection was by application of PVI (10{\%} [w/w (1{\%} w/w available iodine)] povidone iodine in 95{\%} industrial denatured alcohol; Videne Alcoholic Tincture) twice and for 204 patients application of PVI once followed by application of CHG (2{\%} [w/v] chlorhexadine gluconate in 70{\%} [v/v] isopropyl alcohol; Chloraprep with tint). The primary outcome measure was post-skindisinfection surgical site contamination determined by aerobic and anaerobicbacterial growth from post-skin disinfection samples. Results: The detection of viable bacteria in any one of the post-skin disinfection samples (culture-positive) was significantly lower in the group treated with both PVI and CHG than in the group treated with PVI alone: 29.1{\%} (59) vs 41.7{\%} (85), P=0.009; relative risk, 0.574; 95{\%} confidence interval, 0.380 to 0.866. Conclusions: Skin antisepsis with sequential application of PVI and CHG more effectively reduces surgical wound contamination than PVI alone.",
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author = "Sheila Patrick and Andrew McDowell and Andrew Lee and Alessandra Frau and Una Martin and Evie Gardiner and Gregory McLorinan and Niall Eames",
year = "2017",
month = "10",
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volume = "99-B",
pages = "1354--1365",
journal = "Bone and Joint Journal",
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}

Antisepsis of the skin before spinal surgery with povidone iodine alcohol followed by chlorhexidine gluconate-alcohol versus povidone iodine-alcohol applied twice for the prevention of contamination of the wound by bacteria: a randomised controlled trial. / Patrick, Sheila; McDowell, Andrew; Lee, Andrew; Frau, Alessandra; Martin, Una; Gardiner, Evie; McLorinan, Gregory; Eames, Niall.

In: Bone and Joint Journal, Vol. 99-B, 01.10.2017, p. 1354-1365.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Antisepsis of the skin before spinal surgery with povidone iodine alcohol followed by chlorhexidine gluconate-alcohol versus povidone iodine-alcohol applied twice for the prevention of contamination of the wound by bacteria: a randomised controlled trial.

AU - Patrick, Sheila

AU - McDowell, Andrew

AU - Lee, Andrew

AU - Frau, Alessandra

AU - Martin, Una

AU - Gardiner, Evie

AU - McLorinan, Gregory

AU - Eames, Niall

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Aims:To determine if sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in spinal surgery patients. Patients and Methods: A single-centre, interventional, two arm, parallel group randomised controlled trial of 407 patients attending hospital for elective spinal surgery was conducted. For 203 patients, pre-surgical skin disinfection was by application of PVI (10% [w/w (1% w/w available iodine)] povidone iodine in 95% industrial denatured alcohol; Videne Alcoholic Tincture) twice and for 204 patients application of PVI once followed by application of CHG (2% [w/v] chlorhexadine gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint). The primary outcome measure was post-skindisinfection surgical site contamination determined by aerobic and anaerobicbacterial growth from post-skin disinfection samples. Results: The detection of viable bacteria in any one of the post-skin disinfection samples (culture-positive) was significantly lower in the group treated with both PVI and CHG than in the group treated with PVI alone: 29.1% (59) vs 41.7% (85), P=0.009; relative risk, 0.574; 95% confidence interval, 0.380 to 0.866. Conclusions: Skin antisepsis with sequential application of PVI and CHG more effectively reduces surgical wound contamination than PVI alone.

AB - Aims:To determine if sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in spinal surgery patients. Patients and Methods: A single-centre, interventional, two arm, parallel group randomised controlled trial of 407 patients attending hospital for elective spinal surgery was conducted. For 203 patients, pre-surgical skin disinfection was by application of PVI (10% [w/w (1% w/w available iodine)] povidone iodine in 95% industrial denatured alcohol; Videne Alcoholic Tincture) twice and for 204 patients application of PVI once followed by application of CHG (2% [w/v] chlorhexadine gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint). The primary outcome measure was post-skindisinfection surgical site contamination determined by aerobic and anaerobicbacterial growth from post-skin disinfection samples. Results: The detection of viable bacteria in any one of the post-skin disinfection samples (culture-positive) was significantly lower in the group treated with both PVI and CHG than in the group treated with PVI alone: 29.1% (59) vs 41.7% (85), P=0.009; relative risk, 0.574; 95% confidence interval, 0.380 to 0.866. Conclusions: Skin antisepsis with sequential application of PVI and CHG more effectively reduces surgical wound contamination than PVI alone.

KW - Skin

KW - surgery

KW - wound

KW - contamination

KW - antiseptics

KW - povidone iodine-alcohol

KW - chlorhexidine gluconate-alcohol

M3 - Article

VL - 99-B

SP - 1354

EP - 1365

JO - Bone and Joint Journal

T2 - Bone and Joint Journal

JF - Bone and Joint Journal

SN - 2049-4394

ER -