Effect of surgical site skin preparation with povidone-iodine 7.5% and 10% with chlorhexidine and povidone-iodine 10% on microbial count

Document Type : Original Research

Authors

1 iran university of medical sciences

2 Department of Operating Room, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background and Aim: Preparing the skin for surgery with antiseptics is a standard measure to reduce surgical site infection. This study aimed to evaluate the effect of skin preparation at the surgical site with povidone-iodine 7.5% and povidone-iodine 10% antiseptics with chlorhexidine and povidone-iodine 10% on the microbial count.
Methods: This clinical trial study was performed on 80 patients with elective abdominal surgery. Patients were divided into two groups by simple random methods and proportional allocation of skin preparation with povidone-iodine 7.5% and 10% antiseptics or chlorhexidine and povidone-iodine 10% antiseptics. On the day of surgery, the culture sample was taken before the primary skin preparation, then the primary preparation was done with povidone-iodine 7.5% or chlorhexidine in alcohol, then the second culture was taken, the secondary skin preparation was done in both groups with povidone-iodine10% and then the third culture was taken. Specimens of cultures were taken on a blood agar plate and McConkey plate for the examination of microbial count and type, were immediately transferred to the laboratory.
Results: The mean differences in microbial counts before and after skin preparation with povidone-iodine 7.5% and povidone-iodine 10% antiseptics were significant (P=0.001). Also, mean differences in microbial counts before preparation with after skin preparation with chlorhexidine in alcohol antiseptics and povidone-iodine 10% were significant (P<0.001) and in general, both antiseptic groups significantly reduced microbial counts. In comparing the effect of the two groups on the mean microbial count, although the skin preparation with chlorhexidine in alcohol and povidone-iodine 10% antiseptics was better than povidone-iodine 7.5% and povidone-iodine 10% antiseptics, the difference between the two groups was not significant (P=0.324).
Conclusion: Both antiseptic groups were able to significantly reduce the mean microbial counts. Therefore, it is recommended that both antiseptic groups be used to prepare skin for surgery.

Keywords


1. Rothrock JC. Alexander's Care of the Patient in Surgery-E-Book: Elsevier Health Sciences; 2018.p. 360-66 2. Phillips N. Berry & Kohn's operating room technique: Elsevier Health Sciences; 2016.p. 500-06 3. Vernon MO, Hayden MK, Trick WE, Hayes RA, Blom DW, Weinstein RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Archives of Internal Medicine. 2006;166(3):306-12. 4. Darouiche RO, Wall Jr MJ, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. New England Journal of Medicine. 2010;362(1):18-26. 5. Culligan PJ, Kubik K, Murphy M, Blackwell L, Snyder J. A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy. American journal of obstetrics and gynecology. 2005;192(2):422-5. 6. Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. JBJS. 2009;91(8):1949-53. 7. Peel TN, Dowsey MM, Buising KL, Cheng AC, Choong PF. Chlorhexidine-alcohol versus iodine-alcohol for surgical site skin preparation in elective arthroplasty (ACAISA) study: cluster randomised controlled trial. Clinical Microbiology and Infection. 2019. 8. Goldman E, Green LH. Practical handbook of microbiology: CRC press; 2008. 9. Lal Dolat Abad H, Jalali A. Evaluation of the effects of CT-guided neurolytic celiac block for managing intractable upper abdominal pain. Medical Journal of the Islamic Republic of Iran (MJIRI). 2005;18(4):313-7. 10. Surgical site infection.: National Institute for Health and Care Excellence.; Accessed January 22, 2016. [Available from: http://www.nice.org.uk/guidance/qs49/chapter/introduction. 11. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine. 2014;370(13):1198-208. 12. Mardanpour K, Rahbar M, Mardanpour S, Mardanpour N. Surgical site infections in orthopedic surgery: incidence and risk factors at an Iranian teaching hospital. Clinical Trials in Orthopedic Disorders. 2017;2(4):132. 13. Milne J, Vowden P, Fumarola S, Leaper D. Postoperative incision management made easy. Wounds uk. 2012;8(4):1-4. 14. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health care–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA internal medicine. 2013;173(22):2039-46. 15. Lak M, Jalali AR, Badr KS, Hashemi M, Azizabadi FM, Kardavani B, et al. Additional burden of intensive care to rehospitalizations following kidney transplantation a study of rate, causes, and risk factors. Iran J Kidney Dis. 2008;2(4):212-7. 16. Jalali A, Nasiri E, Khoramian M, Saghafinia M, Siamian H. Hemodynamic responses to tracheal intubation in elderly patients: intravenous or spray of lidocaine versus fentanyl. Medical Archives. 2017; 71(6):424. 17. Álvarez CA, Guevara CE, Valderrama SL, Sefair CF, Jimenez MF, Soria CG, et al. Practical recommendations for preoperative skin antisepsis. Infectio. 2018;22(1):46-54. 18. Anggrahita T, Wardhana A, Sudjatmiko G. Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis. Medical Journal of Indonesia. 2017;26(1):54-61. 19. Frasca D, Dahyot-Fizelier C, Mimoz O. Prevention of central venous catheter-related infection in the intensive care unit. Critical Care. 2010;14(2):212. 20. Weinstein RA, Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clinical Infectious Diseases. 2008;46(2):274-81. 21. Durani P, Leaper D. Povidone–iodine: use in hand disinfection, skin preparation and antiseptic irrigation. International Wound Journal. 2008;5(3):376-87. 22. Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews. 2013(3). 23. John B, KK RK, Vipinchandran C. Comparison of efficacy of chlorhexidine alcohol with povidone iodine for prevention of surgical site infection: a prospective study. International Surgery Journal. 2018;5(5):1668-72. 24. Kalb S, Lefevre R, Dididze M, Levi A. The use of anti-septic solutions in the prevention of neurosurgical site infections. Clin Microbiol. 2013;2: 124. 25. Patrick S, McDowell A, Lee A, Frau A, Martin U, Gardner E, et al. 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. The bone & joint journal. 2017;99(10):1354-65. 26. Kavi E, Aarabi A, Sadeqi R, Hashemi SM, Kolahdoozan M, Fazeli H. Effects of Chlorhexidine 2 in Alcohol 70 and Povidone-Iodine 10 on Skin Colonization after Surgical Prep. Pharmacophore. 2017;8(6). 27. Srinivas A, Kaman L, Raj P, Gautam V, Dahiya D, Singh G, et al. Comparison of the efficacy of chlorhexidine gluconate versus povidone iodine as preoperative skin preparation for the prevention of surgical site infections in clean-contaminated upper abdominal surgeries. Surgery today. 2015;45(11): 1378-84. 28. Obamuyide H, Omololu A, Oluwatosin O, Ifesanya A, Fasina A. Comparison of Chlorhexidine-Alcohol and Providone Iodine Skin Preparation Skin Preparation Solutions in Orthopaedic and Trauma Surgery at An African Tertiary Hospital. East and Central African Journal of Surgery. 2015;20(2):80-7. 29. Rao BD, Rao MK. Comparison of Chlorhexidine with povidone–iodine solution for skin disinfection in epidural and central venoues catheter insertion. International Journal of Advances in Medicine. 2017;3(1):101-5. 30. Yoshii T, Hirai T, Yamada T, Sakai K, Ushio S, Egawa S, et al. A Prospective Comparative Study in Skin Antiseptic Solutions for Posterior Spine Surgeries. Clinical spine surgery. 2018;31(7):E353-E6. 31. Xu PZ, Fowler JR, Goitz RJ. Prospective randomized trial comparing the efficacy of surgical preparation solutions in hand surgery. Hand. 2017;12(3):258-64. 32. Blonna D, Allizond V, Bellato E, Banche G, Cuffini AM, Castoldi F, et al. Single versus Double Skin Preparation for Infection Prevention in Proximal Humeral Fracture Surgery. BioMed research international. 2018;2018. 33. Abdeyazdan Z, Majidipour N, Zargham-Boroujeni A. Comparison of the effects of povidone-iodine and chlorhexidine solutions on skin bacterial flora among hospitalized infants. Journal of education and health promotion. 2014;3. 34. Yeung LL, Grewal S, Bullock A, Lai HH, Brandes SB. A comparison of chlorhexidine-alcohol versus povidone-iodine for eliminating skin flora before genitourinary prosthetic surgery: a randomized controlled trial. The Journal of urology. 2013;189(1):136-40. 35. Tuuli MG, Liu J, Stout MJ, Martin S, Cahill AG, Odibo AO, et al. A randomized trial comparing skin antiseptic agents at cesarean delivery. New England Journal of Medicine. 2016;374(7):647-55.