Clinical References Utilizing an Antiseptic

Does preadmission cutaneous chlorhexidine preparation reduce surgical site infections after total knee arthroplasty?

Kapadia BH, Zhou PL, Jauregui JJ, Mont MA

"A prehospital chlorhexidine gluconate wipe protocol appears to reduce the risk of periprosthetic infections after TKA, primarily in those patients with medium and high risk. Although future multicenter randomized trials will need to confirm these preliminary findings, the intervention is inexpensive and is unlikely to be risky and therefore might be considered on the basis of this retrospective, comparative study."

Single vs repeat surgical skin preparations for reducing surgical site infection after total joint arthroplasty: A prospective, randomized, double-blinded study

Morrison TN, Chen AF, Taneja M, Küçükdurmaz F, Rothman RH, Parvizi J

"Reapplication of [a surgical site preparation solution] after draping and before the application of iodophor-impregnated incisive draping resulted in a significant reduction in the rate of SSI in patients undergoing elective TJA."

Antimicrobial formulation and delivery in the prevention of surgical site infection

O'Neal PB, Itani KM

"Proper dosing and re-dosing of prophylactic intravenous antibiotics should become standard practice. Continuation of intravenous antibiotic prophylaxis beyond wound closure is unnecessary in clean cases and remains controversial in clean-contaminated and complex cases. Oral antibiotic bowel preparation is an important adjunct to intravenous antibiotic prophylaxis in colorectal surgery. The use of topical antimicrobial and antiseptic agents such as antibacterial irrigations, local antimicrobial application, antimicrobial-coated sutures, antibacterial wound sealants, and antimicrobial impregnated dressings in the prevention of SSI is questionable."

Infection prevention in breast implant surgery – A review of the surgical evidence, guidelines and a checklist

Barr SP, Topps AR, Barnes NL, Henderson J, Hignett S, Teasdale RL, McKenna A, Harvey JR, Kirwan CC; Northwest Breast Surgical Research Collaborative

"We have produced a perioperative "Theatre Implant Checklist" for SSI prevention in implant-based breast surgery, with a set of pragmatic up to date guidelines, which allows the reader to evaluate the evidence upon which our recommendations are based."

Efficiency of local antiseptic Alkosol (ethanol, isopropanol-30g and ortophenilphenol) and povidone iodide on the incidence of surgical site infection after inguinal hernioplasty

Djozic H, Pandza H, Hasukic S, Custovic S, Pandza B, Krupalija A, Beciragic E

"We consider that both optimal timing of preoperative skin preparation and the choice of antiseptics play an important role in the prevention of SSIs. The combination of two antiseptics that are applied one after another could decrease SSIs rate. The time interval between the initial application of the antiseptic and the surgical incision can also be an important factor. An adequate clinical trial would give further insight into the connection. In cases of SSIs that occur in patients that underwent clean surgery the cause is usually contamination that patients acquire before hospitalization."

A bundle that includes active surveillance, contact precaution for carriers, and cefazolin-based antimicrobial prophylaxis prevents methicillin-resistant Staphylococcus aureus infections in clean orthopedic surgery

Kawamura H, Matsumoto K, Shigemi A, Orita M, Nakagawa A, Nozima S, Tominaga H, Setoguchi T, Komiya S, Tokuda K, Nishi J

"An infection-prevention bundle consisting of contact precautions for carriers and AMP stewardship in addition to active surveillance was associated with a significant decrease in the incidence of orthopedic MRSA SSIs."

Frequent isolation of Propionibacterium acnes from the shoulder dermis despite skin preparation and prophylactic antibiotics

Phadnis J, Gordon D, Krishnan J, Bain GI

"Viable P acnes persists within the skin dermis, despite standard antimicrobial precautions. These findings suggest that incising the skin is likely to lead to deep seeding of the surgical wound, which has implications for the pathogenesis and prevention of postsurgical shoulder infections."

Reduction of surgical site infections after laparoscopic gastric bypass with circular stapled gastrojejunostomy

Shabino PJ, Khoraki J, Elegbede AF, Schmocker RK, Nabozny MJ, Funk LM, Greenberg JA, Campos GM

"Use of a stapler cover, wound irrigation, wound antibiotic application, and primary wound closure were associated with a significantly lower wound infection rate after [Laparoscopic Roux-en-Y Gastric Bypass] with the circular stapled [Gastrojejunostomy]. The observed SSI rates after our intervention are similar to those reported after hand-sewn and linear stapled techniques. In addition, other factors associated with decreasing the likelihood of developing SSI were use of chlorhexidine-based prep and maintaining intraoperative normothermia."

Randomized, prospective study of the order of preoperative preparation solutions for patients undergoing foot and ankle orthopedic surgery

Hunter JG, Dawson LK, Soin SP, Baumhauer JF

"Postoperative infection rates following foot and ankle orthopedic surgery was low. Both chlorhexidine and isopropyl alcohol solutions were effective methods in reducing operative site bacterial colonization when combined. In this study, applying isopropyl alcohol solution followed by the chlorhexidine solution was more effective in reducing positive bacterial cultures taken after operative site preparation. No difference in clinical wound infection rate was seen."

The combined impact of surgical team education and chlorhexidine 2% alcohol on the reduction of surgical site infection following cardiac surgery

Hannan MM, O'Sullivan KE, Higgins AM, Murphy AM, McCarthy J, Ryan E, Hurley JP

"Using CHG as pre-operative antiseptic in cardiothoracic surgery in a risk-adjusted cohort with education of the surgical team is associated with significantly lower SSI infection rates when compared with [alcohol povidone iodine]. Emphasis must be placed on the multifactorial approach required to prevent postoperative wound infections."

Organizational culture changes result in improvement in patient-centered outcomes: Implementation of an integrated recovery pathway for surgical patients

Wick EC, Galante DJ, Hobson DB, Benson AR, Lee KH, Berenholtz SM, Efron JE, Pronovost PJ, Wu CL

"Our trust-based accountability model, which included both senior hospital leadership and frontline providers, provided an enabling structure to rapidly implement an integrated recovery pathway and quickly improve outcomes, value, and experience of patients undergoing colorectal surgery. The study findings have significant implications for spreading surgical quality improvement work."

A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5% w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting

Casey A, Itrakjy A, Birkett C, Clethro A, Bonser R, Graham T, Mascaro J, Pagano D, Rooney S, Wilson I, Nightingale P, Crosby C, Elliott T

"Isopropyl alcohol (70%) containing 2% CHG compared with 0.5% CHG reduces the number of microorganisms detectable on a surgical patient's skin perioperatively."

Effect of perioperative mupirocin and antiseptic body wash on infection rate and causative pathogens in patients undergoing cardiac surgery

Kohler P, Sommerstein R, Schönrath F, Ajdler-Schäffler E, Anagnostopoulos A, Tschirky S, Falk V, Kuster SP, Sax H

"Mupirocin and antiseptic body wash reduced the rate of superficial but not deep or organ/space SSIs. Postoperative patient treatment may be critical in reducing the risk for superficial SSI, presumably due to a reduction of bacterial skin load. A high proportion of SSI was due to methicillin-resistant [coagulase-negative Staphylococci] and thus not covered by routine perioperative antimicrobial prophylaxis."

Propionibacterium can be isolated from deep cultures obtained at primary arthroplasty despite intravenous antimicrobial prophylaxis

Matsen FA 3rd, Russ SM, Bertelsen A, Butler-Wu S, Pottinger PS

"Preoperative antibiotics and skin preparation do not always eliminate Propionibacterium from the surgical field of primary shoulder arthroplasty. The presence of these bacteria in the arthroplasty wound may pose a risk of delayed shoulder arthroplasty failure from the subtle type of periprosthetic infection typically associated with Propionibacterium."

Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery

Schweizer ML, Chiang HY, Septimus E, Moody J, Braun B, Hafner J, Ward MA, Hickok J, Perencevich EN, Diekema DJ, Richards CL, Cavanaugh JE, Perlin JB, Herwaldt LA

"In this multicenter study, a bundle comprising S. aureus screening, decolonization, and targeted prophylaxis was associated with a modest, statistically significant decrease in complex S. aureus SSIs."

Perioperative skin preparation and draping in modern total joint arthroplasty: Current evidence

Markatos K, Kaseta M, Nikolaou VS

"The importance of skin preparation and adequate and reliable draping cannot be overemphasized for infection prevention, especially in clean operations such as THR and TKR. Thorough and strict protocols are mandatory for every department, as well as education curricula for operating room personnel. Further randomized studies are mandatory to specify the effect of the above measures, their pitfalls, and their improvement, along with further crucial details such as cost-benefit analysis of different pre-operative preparations in preventing infections."

Infection prevention in total knee arthroplasty

Daines BK, Dennis DA, Amann S

"The use of laminar flow rooms, proper skin preparation, limiting operating room traffic, and the use of various wound closure techniques can help to decrease infection rates. Postoperatively, optimal management of indwelling urinary catheters, blood transfusions, and wound drainage also may decrease infection rates."

Chlorhexidine with isopropyl alcohol versus iodine povacrylex with isopropyl alcohol and alcohol- versus nonalcohol-based skin preparations: The incidence of and readmissions for surgical site infections after colorectal operations

Kaoutzanis C, Kavanagh CM, Leichtle SW, Welch KB, Talsma A, Vandewarker JF, Lampman RM, Cleary RK

"The use of 2.0% chlorhexidine with 70.0% isopropyl alcohol versus 0.7% iodine povacrylex with 74.0% isopropyl alcohol or alcohol-based versus nonalcohol-based skin preparations does not significantly influence the incidence of surgical site infections or readmission within 30 days for surgical site infection after clean-contaminated colorectal operations."

A new surgical site infection improvement programme for New Zealand: Early progress

Morris AJ, Panting AL, Roberts SA, Shuker C, Merry AF

"Through a combined package of surveillance and improvement interventions the SSII Programme aims to reduce the incidence of SSIs in New Zealand hospitals, beginning initially with hip and knee arthroplasties. Within one year of the programme starting there has been a significant nationwide improvement in the timing of surgical antimicrobial prophylaxis (p<0.0001), and the administration of the correct dose (p<0.0001). National compliance with an alcohol-based skin preparation remains high at > 95 %. In this paper we describe the purpose, background, structure and rationale of the programme and provide results to date. "

Infection after hand surgery

Eberlin KR, Ring D

"Measures intended to reduce the risk of infection after hand surgery include hand washing, skin preparation, sterile technique, and prophylactic antibiotics. The role of prophylactic antibiotics for small, clean, elective hand surgery procedures lasting less than 2 hours is debated. "

Skin preparation before surgery: Options and evidence

Sidhwa F, Itani KM

"Alcohol-based agents are likely superior to aqueous agents. Chlorhexidine may decrease SSI rates compared with povidone-iodine, and chlorhexidine-isopropyl alcohol likely offers better skin decontamination before clean surgery than povidone-iodine plus isopropyl alcohol or iodine povacrylex plus isopropyl alcohol. The quality of the available data is moderate. Rigorous, well-powered RCTs with appropriate treatment comparisons are needed to establish the optimal and most cost-effective pre-operative skin preparation in various operations and wound classifications."

Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: A systematic review and meta-analysis

Mueller TC, Loos M, Haller B, Mihaljevic AL, Nitsche U, Wilhelm D, Friess H, Kleeff J, Bader FG

"These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications."

Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections

Haas DM, Morgan S, Contreras K

"Vaginal preparation with povidone-iodine solution immediately before cesarean delivery reduces the risk of postoperative endometritis. This benefit is particularly realized for women undergoing cesarean delivery, who are already in labor or who have ruptured membranes. As a simple, generally inexpensive intervention, providers should consider implementing preoperative vaginal cleansing with povidone-iodine before performing cesarean deliveries."

Efficacy of skin preparation in eradicating organisms before total knee arthroplasty

Boe E, Sanchez HB, Kazenske FM, Wagner RA

"BMI was a statistically significant factor in predicting presence of isolates after solution application. In addition, presence of bacteria in presolution cultures was predictive of isolation in postsolution cultures. Diabetic patients were 3.6 times more likely than nondiabetic patients to have a bacterial isolate. Other factors did not predict organism isolation. No patient developed a postoperative infection."

Surgical site infection in surgery for benign prostatic hyperplasia: Comparison of two skin antiseptics and risk factors

Abreu D, Campos E, Seija V, Arroyo C, Suarez R, Rotemberg P, Guillama F, Carvalhal G, Campolo H, Machado M, Decia R

"In a cohort of patients submitted to open prostatectomy, SSI was not related to the type of antiseptic. The main risk factor was the presence of a urinary catheter preoperatively. All microorganisms isolated from the SSIs were characteristic of urinary tract infections."

The effect of preoperative skin preparation products on surgical site infection

Young HL, Reese S, Knepper B, Miller A, Mauffrey C, Price CS

"Skin preparation products contribute to surgical site infection (SSI) prevention. In a case-control study, diabetes was associated with increased SSI (adjusted odds ratio [OR], 5.74 [95% confidence interval (CI), 1.22-27.0]), while the use of chlorhexidine gluconate (CHG) plus isopropyl alcohol versus CHG alone was found to be protective (adjusted OR, 2.64 [95% CI, 1.12-6.20]). "

Toward zero: Deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: Implications for diabetic patients

Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I

"The measures applied caused a substantial reduction in [Deep Sternal Wound Infection]. Key measures included the use of chlorhexidine-alcohol and avoidance of [Bilateral Internal Thoracic Artery] grafting in obese diabetic females. These measures reduced DSWIs after BITA grafting in most diabetics."

Factors associated with surgical site infection after lower extremity bypass in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI)

Kalish JA, Farber A, Homa K, Trinidad M, Beck A, Davies MG, Kraiss LW, Cronenwett JL

"In-hospital SSI after [lower extremity bypass] varies substantially across VQI hospitals. Three modifiable processes of care (transfusion rate, procedure time, and type of skin preparation) were identified and may be used by hospitals to reduce SSI rates. This study demonstrates the value of the SVS VQI detailed shared clinical registry to identify improvement opportunities directly pertinent to providers that are not available in typical administrative data sets."

Skin preparation for preventing infection following caesarean section

Hadiati DR, Hakimi M, Nurdiati DS, Ota E

"This review found that chlorhexidine gluconate compared with iodine alone was associated with lower rates of bacterial growth at 18 hours after caesarean section. However, this outcome was judged as very low quality of evidence. Little evidence is available from the included randomised controlled trials to evaluate different agent forms, concentrations and methods of skin preparation for preventing infection following caesarean section. Therefore, it is not yet clear what sort of skin preparation may be most efficient for preventing postcaesarean wound and surgical site infection.There is a need for high-quality, properly designed randomised controlled trials with larger sample sizes in this field. High priority questions include comparing types of antiseptic (especially iodine versus chlorhexidine), the timing and duration of applying the antiseptic (especially previous night versus day of surgery, and application methods (scrubbing, swabbing and draping)."

Propionibacterium persists in the skin despite standard surgical preparation

Lee MJ, Pottinger PS, Butler-Wu S, Bumgarner RE, Russ SM, Matsen FA

"This study found that Propionibacterium persists in the dermal tissue even after surface skin preparation with ChloraPrep. The 70% rate of persistence of propionibacteria after skin preparation is substantially higher than previously reported."

Preoperative skin disinfection methodologies for reducing prosthetic joint infections

Banerjee S, Kapadia BH, Mont MA

"Advanced preoperative whole-body cleaning with chlorhexidine-containing cloths rather than site-specific application may confer additional advantages. Further randomized controlled trials with carefully planned protocols and endpoints are needed to determine if this conclusively leads to reduction in the rate of surgical site infections."

New strategies for preoperative skin antisepsis

Ulmer M, Lademann J, Patzelt A, Knorr F, Kramer A, Koburger T, Assadian O, Daeschlein G, Lange-Asschenfeldt B

"Modern technologies such as tissue-tolerable plasma (TTP) have been tested for their potential antiseptic efficiency by reducing the bacterial load in the skin and in the hair follicles. First experiments using liposomes to deliver antiseptics into the hair follicles have been evaluated for their potential clinical application. The present review evaluates these two innovative methods for their efficacy and applicability in preoperative skin antiseptics."

A retrospective analysis of surgical site infections after chlorhexidine-alcohol versus iodine-alcohol for pre-operative antisepsis

Charehbili A, Swijnenburg RJ, van de Velde C, van den Bremer J, van Gijn W

"In this single-center study conducted over a course of one year with each of the preparations investigated, no difference in the rate of SSI was found after an instantaneous protocol change from iodine-alcohol to chlorhexidine-alcohol for pre-operative topical antisepsis."

Incidence and risk factors for acute infection after proximal humeral fractures: A multicenter study

Blonna D, Barbasetti N, Banche G, Cuffini AM, Bellato E, Massè A, Marenco S, Battiston B, Castoldi F

"This study suggests that washing the shoulder with chlorhexidine gluconate and avoiding the use of first-generation cephalosporin in favor of more effective prophylactic therapy are effective at reducing the risk of infection after treatment for proximal humeral fractures."

Comparative effectiveness of skin antiseptic agents in reducing surgical site infections: A report from the Washington State Surgical Care and Outcomes Assessment Program

Hakkarainen TW, Dellinger EP, Evans HL, Farjah F, Farrokhi E, Steele SR, Thirlby R, Flum DR; Surgical Care and Outcomes Assessment Program Collaborative

"For clean-contaminated surgical cases, this large-scale state cohort study did not demonstrate superiority of any commonly used skin antiseptic agent in reducing the risk of SSI, nor did it find any unique effect of isopropyl alcohol. These results do not support the use of more expensive skin preparation agents."

Economic Evaluation of Chlorhexidine Cloths on Healthcare Costs due to Surgical Site Infections Following Total Knee Arthroplasty

Kapadia BH, Johnson AJ, Issa K, Mont MA

A study evaluated the overall potential, annual healthcare cost savings of adding a pre-operative chlorhexidine cloth preparation protocol for SSI reduction following total knee arthroplasty (TKA). Using previously published reports, including those from the National Healthcare Safety Network (NHSN), this study found that potential annual healthcare savings from this protocol ranged from $0.78 to $3.18 billion primarily by decreasing the incidence of surgical site infection.

Can we reduce the surgical site infection rate in cesarean sections using a Chlorhexidine-based antisepsis protocol?

Amer-Alshiek J, Alshiek T, Almog B, Lessing JB, Satel A, Many A, Levin I

A retrospective study of 326 women undergoing elective and non-elective cesarean section compared two different antisepsis protocols for the reduction of surgical site infection rates. One group of 163 patients were treated with 10% povidone-iodine scrub followed by povidione-iodine 10% in 65% alcohol, and the other group of 163 patients were treated with chlorhexidine 2% followed by 70% alcohol.The study concluded that a chlorhexidine-based antisepsis regimen was associated with significant reduction in the rate of SSI compared to a povidone-iodine antisepsis regimen.

Most relevant strategies for preventing surgical site infection after total hip arthroplasty: Guideline recommendations and expert opinion

Merollini KM, Zheng H, Graves N

A review of four clinical guidelines, 11 structured interviews and 19 online surveys of infection control practitioners, infectious disease physicians and orthopedic surgeons yielded 28 infection prevention measures to prevent SSI in total hip arthroplasty. The study found 7 prevention measures that were identified by experts as being highly important: antibiotic prophylaxis, antiseptic skin preparation of patients, hand-forearm antisepsis by surgical staff, sterile gowns/surgical attire and surveillance. Antibiotic-impregnated cement and ultraclean/laminar air operating theaters were controversial measures.

Skin preparation for preventing infection following caesarean section (Review)

Hadiati DR, Hakimi M, Nurdiati DS

A review of five trials including a total of 1,462 women undergoing Caesarean section compared how different agent forms and methods of preoperative skin preparation would aid in preventing postop infection. Based on lacking evidence from these trials, it is not yet clear what sort of skin preparation may be most efficient for preventing postcaesarean wound and surgical site infection.

Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (Review)

Webster J, Osborne S

A review of seven trials including a total of 10,157 subjects examined the evidence for whether preoperative bathing or showering with antiseptics helps prevent surgical site infections. This review provides no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated.

No Risk of Surgical Site Infections From Residual Bacteria After Disinfection With Povidone-Iodine-Alcohol in 1014 Cases: A Prospective Observational Study

Tschudin-Sutter S, Frei R, Egli-Gany D, Eckstein F, Valderrabano V, Dangel M, Battegay M, Widmer AF

A prospective observational study assessing 1,014 skin cultures from 1,005 patients concluded that povidone-iodine-alcohol was effective for preparing the preoperative site, resulting in a low rate of surgical site infections.

Self-administered preoperative antiseptic wash to prevent postoperative infection after deep brain stimulation

Halpern CH, Mitchell GW, Paul A, Kramer DR, McGill KR, Buonacuore D, Kerr M, Jaggi JL, Stern JJ, Baltuch GH

A retrospective review of 165 patients undergoing deep brain stimulation (DBS) surgery were all required to use a preoperative alcohol-based preparation the night before surgery and the morning of surgery. The results support the incorporation of this self-administered antiseptic wash into their standard antiseptic protocol for patients undergoing DBS surgery.

Should surgeons scrub with chlorhexidine or iodine prior to surgery?

Jarral OA, McCormack DJ, Ibrahim S, Shipolini AR

A review of 593 papers that analyzed the difference between a chlorhexidine and iodine scrub found that chlorhexidine had a more profound and longer lasting effect in reducing bacterial count after scrubbing compared to povidone-iodine.

Chlorhexidine and Alcohol Versus Povidone-Iodine for Antisepsis in Gynecological Surgery

Levin I, Amer-Alshiek J, Avni A, Lessing JB, Satel A, Almog B

A retrospective study including 256 patients (145 with povidone-iodine 10% scrub followed by 10% povidone-iodine in 65% alcohol and 111 with chlorhexidine 2% followed by 70% alcohol) undergoing gynecologic elective laparotomies demonstrated that antisepsis with chlorhexidine and alcohol was associated with a significant reduction in the rate of SSIs compared to povidone-iodine antisepsis.

Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery

Noorani A, Rabey N, Walsh SR, Davies RJ

A meta-analysis of six studies involving 5,031 patients investigated whether preoperative skin cleansing with chlorhexidine or povidone-iodine reduced surgical site infection in clean-contaminated surgery. The study found that preoperative skin antisepsis with clorhexidine is superior to povidone-iodine in reducing postoperative SSI after clean-contaminated surgery.

Educational intervention, revised instrument sterilization methods, and comprehensive preoperative skin preparation protocol reduce cesarean section surgical site infections

Rauk PN

A study of patients undergoing c-sections concluded that the implementation of a comprehensive staff education and training program, using chlorhexidine gluconate [CHG] no-rinse cloths for a preoperative skin prep, using CHG with alcohol for intraoperative skin prep and appropriate instrument sterilization management led to a reduction in surgical site infection.

Chlorohexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis

Darouiche RO, Wall MJ, Itani KMF, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, AlSharif A, Berger DH

A prospective, randomized trial of 849 patients undergoing clean-contaminated surgery found that preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior than cleansing with a povidone-iodine scrub for preventing surgical site infection.

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

Swenson BR, Hedrick TL, Metzger R, Bonatti H, Pruett TL, Sawyer RG

A prospective study of 3 skin preparation protocols implemented during 3,209 general surgery operations found that using iodine povacrylex in isopropyl alcohol showed the lowest infection rate compared to povidone-iodine scrub-paint combination with an isopropyl alcohol application and 2% chlorhexidine and 70% isopropyl alcohol.

Efficacy of Surgical Preparation Solutions in Shoulder Surgery

Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL

A prospective study including 150 patients undergoing shoulder surgery determined that use of ChloraPrep is more effective than DuraPrep and povidone-iodine at eliminating overall bacteria from the shoulder region. No postoperative infections developed in any patients using skin preparation in this study at a minimum 10 month follow-up after surgery.

Comparison of Surgical Wound Infection after Preoperative Skin Preparation with 4% Chlorhexidine and Povidone Iodine: A Prospective Randomized Trial

Paocharoen V, Mingmalairak C, Apisarnthanarak A

A randomized trial including 500 surgical patients (povidone iodine and chlorhexidine were used for skin preparation in group 1 and 2 respectively) concluded that colonization of bacterial and postoperative wound infection were significantly reduced in the chlorhexidine group.

Effects of Applying Povidone-Iodine Just before Skin Closure

Harihara Y, Konishi T, Kobayashi H, Furushima K, Ito K, Noie T, Nara S, Tanimura K

A study including 107 cases of gastric and colorectal surgery were randomly assigned to two groups, one with povidone-iodine applied to the skin around the incision before skin closure and one without povidone-iodine applications. The povidone-iodine was effective in eliminating skin contamination; however, the number of cases in this study was too small to determine whether or not the use of povidone iodine affected wound infection rates.

Surgical site infection rates following cardiac surgery: The impact of a 6-year infection control program

Finkelstein R, Rabino G, Mashiah T, Bar-El Y, Adler Z, Kertzman V, Cohen O, Milo S

A prospective cohort study including patients undergoing 2,051 cardiac operations concluded a significant reduction in organ/space infection rates with the use of povidone-iodine scrub showers, prospective surveillance, depilation before surgery, administration of preoperative antibiotic prophylaxis in the operating room and post discharge follow-up.

Chlorhexidine Provides Superior Skin Decontamination in Foot and Ankle Surgery

Bibbo C, Patel DV, Gehrmann RM, Lin SS

A prospective, randomized study including 127 patients (67 received povidone iodine, 60 received a chlorhexidine scrub and isopropyl alcohol paint) undergoing clean elective foot and ankle surgery indicated that chlorhexidine and alcohol provide better reduction in bacterial carriage than povidone-iodine. Based on these data, chlorhexidine was recommended as the surgical preparatory agent for the foot and ankle.

Efficacy of Surgical Preparation Solutions in Foot and Ankle Surgery

Ostrander RV, Botte MJ, Brage ME

A prospective study including 125 consecutive patients undergoing foot and ankle surgery concluded that the combination of chlorhexidine and alcohol was the most effective preparation for eliminating bacteria from the forefoot prior to surgery.

Research Studies Utilizing an Antiseptic