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

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

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Aims
The aim of this study was to determine whether the 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 patients undergoing spinal surgery.

Patients and Methods
A single-centre, interventional, two arm, parallel group randomised controlled trial was undertaken, involving 407 patients who underwent elective spinal surgery.

For 203 patients, the skin was disinfected before surgery using PVI (10% [w/w (1% w/w available iodine)] in 95% industrial denatured alcohol, povidone iodine; Videne Alcoholic Tincture) twice, and for 204 patients using PVI once followed by CHG (2% [w/v] chlorhexidine gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint). The primary outcome measure was contamination of the wound determined by aerobic and anaerobic bacterial growth from samples taken after disinfection.

Results
The detection of viable bacteria in any one of the samples taken after disinfection (culture-positive) was significantly lower in the group treated with both PVI and CHG than in the group treated with PVI alone (59 (29.1%) versus 85 (41.7%), p = 0.009; odds ratio 0.574; 95% confidence interval, 0.380 to 0.866).

Conclusions
Antisepsis of the skin with the sequential application of PVI and CHG more effectively reduces the contamination of a surgical wound than PVI alone.
Original languageEnglish
Pages (from-to)1354-1365
Number of pages11
JournalBone and Joint Journal
Volume99-B
Issue number10
Early online date1 Oct 2017
DOIs
Publication statusPublished - 1 Oct 2017

Keywords

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

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