Skin Preparation Methods in Foot and Ankle Surgery

NewsBot · Jul 21, 2015

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Randomised Comparison of Two Skin Preparation Methods in Foot and Ankle Surgery
Chang Alice et al
Foot and Ankle Surgery; 20 July 2015

Highlights
•Equivalent preparation time within the bag immersion group.
•No significant formation of bacterial growth in either preparation technique groups.
•The immersion technique is as effective as the current standard painting procedures.
•Non-sterile bag is safe to use with a simple technique.
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Background
Foot and ankle surgery has an increased incidence of post-operative surgical site infections. The aim of this study was to examine the efficacy and efficiency of an alternative method of surgical site preparation for foot and ankle surgery.

Method
Fifty one volunteers were recruited for this study which compared standard gauze painting using 2% chlorhexidine with 70% alcohol to immersion of the foot and ankle in a non-sterile bag filled with 60 mL of the same solution and rubbing all skin surfaces (bag immersion method). Each method was applied to different feet of each volunteer in a randomized order. Commercially available impression agar slides were used to measure bacteria colony-forming-unit (CFU) counts from four areas of each foot after allowing the preparation to dry. Outcomes included CFU count and preparation time.

Result
There was no difference between the methods in terms of CFU count (0 total CFU vs 1). Preparation time was significantly shorter for the bag immersion method (63.98 sec vs 67.98 sec). Two-side 90% confidence intervals (2.03-6.00) for the difference in means of preparation time demonstrated equivalence using a margin of ±20%.

Conclusions
The bag immersion method is a valid alternative, equivalent in preparation timing and the elimination of transient skin flora when using 2% Chlorhexidine with 70% alcohol
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Admin2 · Jul 21, 2015

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Evidence base of pre-op skin preparation

NewsBot · Sep 8, 2015

Antimicrobial efficacy of preoperative skin antisepsis and clonal relationship to postantiseptic skin-and-wound flora in patients undergoing clean orthopedic surgery
G. Daeschlein , M. Napp , F. Layer, S. von Podewils, H. Haase, R. Spitzmueller, O. Assadian, R. Kasch, G. Werner and 3 more
European Journal of Clinical Microbiology & Infectious Diseases; 04 September 2015

Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany. Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound base, wound margin, and the suture of 137 patients. Seventy-four patients during phase I and 63 during phase II were investigated. Microbial growth, species spectrum, and antibiotic susceptibility were analyzed. In phase two, the clonal relationship of strains was additionally analyzed. 18.0 % of the swab samples were positive for bacterial growth in the wound base, 24.5 % in the margin, and 27.3 % in the suture. Only 65.5 % of patients showed a 100 % reduction of the skin flora after antisepsis. The microbial spectrum in all postantiseptic samples was dominated by coagulase-negative staphylococci (CoNS). Clonally related staphylococci were detected in ten patients [nine CoNS, one methicillin-susceptible Staphylococcus aureus (MSSA)]. Six of ten patients were suspected of having transmitted identical clones from skin flora into the wound. Ethanol-based antisepsis results in unexpected high levels of skin flora, which can be transmitted into the wound during surgery causing yet unexplained SSI. Keeping with the concept of zero tolerance, further studies are needed in order to understand the origin of this flora to allow further reduction of SSI.
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NewsBot · Dec 18, 2015

Randomized, Prospective Study of the Order of Preoperative Preparation Solutions for Patients Undergoing Foot and Ankle Orthopedic Surgery
Joshua G. Hunter et al
Foot & Ankle International December 17

Background: Surgical site infection is routinely cited as the most common complication following orthopedic foot and ankle surgery. Our institution uses 4% chlorhexidine gluconate followed by 70% isopropyl alcohol to reduce skin bacterial loads prior to surgery. These solutions have potential synergistic qualities to prevent a postoperative infection. The purpose of this study was to determine if the order of these solutions has a significant effect on the residual bacterial pathogens load following operative site preparation for foot and ankle surgery, as evidenced by positive culture swabs.
Methods: A total of 95 consecutive patients, undergoing surgery of the foot and ankle with a single surgeon, were prospectively randomized to 1 of 2 operative preparation groups: isopropyl alcohol (IPA) group, whose operative site preparation consisted of a 4% chlorhexidine application followed by alcohol rinse (49 patients), and chlorhexidine gluconate (CHG) group, which had 46 patients undergo operative site preparation using alcohol followed by chlorhexidine. A total of 4 aerobic culture specimens were obtained from the third web space of the operative foot on each patient: (1) prior to operative site preparation, (2) after the prep was completed, (3) after completion of the procedure, and (4) after the incision was closed. Each patient was then followed for 6 months postoperatively to monitor the operative site. Medical comorbidities were also analyzed.
Results: The average time for IPA procedures was 52 minutes vs 54 for CHG (ns). There was no difference between groups with respect to diabetes, tobacco use, obesity, race, or immunosuppression. Both groups had 100% bacterial growth from specimens obtained prior to operative site preparation (P > .05). For all postpreparation swabs, 19.0% (28/147) of the IPA cultures were positive compared to 10.9% (15/138) from the CHG group cultures (P = .07). The amount of patients with positive culture results favored the CHG group at each collection point: 6.5% (3/46) versus 25% (12/49) after draping (P = .02); 15% (7/46) versus 33% (16/49) after completion of the surgery (P = .05); and 20% (9/46) versus 35% (17/49) after skin closure (P = .07). One operative site infection was seen in the first 30 days following surgery for each treatment group, each treated with oral antibiotics. No additional skin or wound complications were encountered during the 6-month study follow-up.
Conclusion: 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.
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NewsBot · Jul 13, 2018

Preoperative disinfection of foot and ankle: microbiological evaluation of two disinfection methods.
Dingemans SA et al
Arch Orthop Trauma Surg. 2018 Jul 10.

BACKGROUND:
The aim of the current study was to investigate the effect of a footbath in alcohol prior to preoperative disinfection on bacterial flora of the foot and ankle.

METHODS:
Twenty-two volunteers underwent skin preparation mimicking pre-surgical disinfection. One foot was submerged in a bag filled with 70% ethanol containing 10% IPA for 5 min after which it was painted with regular 0.5% chlorhexidine in 70% alcohol. The other foot was only painted with 0.5% chlorhexidine in 70% alcohol. Swabs were taken at four locations: (1) under the nailfold of the first toe, (2) first webspace, (3) sinus tarsi and (4) pre-tibial. A quantitative and qualitative analysis of the cultures was performed.

RESULTS:
No statistically significant difference between the number of positive cultures between the two methods was observed. The number of colony forming units was statistically significantly lower on two locations in the footbath group (i.e., subungual and the first webspace) (median 1 versus median 92 p =0.03 and median 0 versus median 1 p =0.03, respectively). The number of cultures with heavy growth was lower in the footbath group under the nailfold of the first toe (5 versus 13 p =0.008). Thirty-eight different microorganisms were cultured.

CONCLUSION:
A footbath in alcohol prior to regular preoperative skin antisepsis significantly reduces the amount of bacteria under the nailfold and in the first webspace. The number of cultures with heavy growth is lower after a footbath in alcohol
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NewsBot · Sep 27, 2023

Effectiveness of chlorhexidine versus povidone-iodine for preventing surgical site wound infection: A meta-analysis
Panfeng Wang, Dandan Wang, Lingqiao Zhang
26 September 2023

A systematic evaluation was conducted to assess the efficacy of two disinfectants, chlorhexidine and povidone-iodine, as primary components in preventing surgical site infection (SSI). A comprehensive computerised search was performed in the PubMed, EMBASE, Web of Science, Cochrane Library, CNKI and Wanfang databases for randomised controlled trials (RCTs) on chlorhexidine and povidone-iodine disinfection for the prevention of SSI from inception until July 2023. Two independent researchers completed literature screening, data extraction and quality assessment of the included studies. The meta-analysis was conducted using RevMan 5.4 software. Ultimately, 20 RCTs were included, which included 13 133 patients, with 6460 patients in the chlorhexidine group and 6673 patients in the povidone-iodine group. The meta-analysis results revealed that the incidence rate of surgical site wound infections [odds ratio (OR): 0.67, 95% confidence interval (CI): 0.58–0.78, p < 0.001)], superficial SSI rate (OR: 0.59, 95% CI: 0.46–0.75, p < 0.001) and deep SSI rate (OR: 0.49, 95% CI: 0.31–0.79, p = 0.003) were all lower in patients subjected to chlorhexidine disinfection compared to those patients receiving povidone-iodine disinfection. Existing evidence suggests that chlorhexidine is more effective than povidone-iodine at preventing SSI. However, owing to the potential quality limitations of the included studies, further validation through high-quality large-scale RCTs is warranted.
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Skin Preparation Methods in Foot and Ankle Surgery

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Admin2 Administrator Staff Member

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Skin Preparation Methods in Foot and Ankle Surgery

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

product for skin preparation

Preoperative skin preparations

Evidence base of pre-op skin preparation

Podiatric Skin and Nail Involvement and Biomechanical Pathology in Renal Transplant Recipients

Diabetic Foot Ulcers in Skin of Color

Skin Conditions in Dancers

Verrucous Skin Lesions on the Feet in Diabetic Neuropathy

Share This Page

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