Antiseptic Skin Agents for Percutaneous Procedures (original) (raw)
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Pacing and Clinical Electrophysiology, 2014
associated with increased morbidity and mortality. Recent data suggested a relationship between the antiseptic agent used for skin preparation at time of CIED procedure and risk for infection. Methods: On April 30, 2011, we changed the antiseptic agent used for skin preparation at our tertiary care facility from chlorhexidine-alcohol to povidone-iodine for all CIED procedures. We retrospectively reviewed records of all patients who underwent CIED procedure 1 year before and after the change. CIED infection was defined as pocket or endovascular systemic infection that required removal within 1 year of the index procedure. We examined if the change affected the risk of CIED infection. Results: A total of 2,792 patients underwent 2,840 CIED procedures; 1,748 (61.5%) had implantable cardioverter defibrillator procedures and 1,092 (38.4%) had permanent pacemaker procedures. Chlorhexidine-alcohol agent was used in 1,450 (51.1%) procedures, and povidone-iodine agent was used in 1,390 (48.9%). After 1 year of follow-up, 31 patients (1.09%) developed CIED infection that required system removal. The 1-year infection rate was 1.1% among both antiseptic agent groups and there were no significant differences in the infection presentations among both groups (P = 0.950). Multivariate Cox proportional hazards regression model showed that risk factors for infection within 1 year included age, diabetes, and African American race.
An Overview of Skin Antiseptics Used in Orthopaedic Surgery Procedures
Journal of the American Academy of Orthopaedic Surgeons, 2018
Surgical site infections (SSIs) in orthopaedics are a common complication, with more than half a million SSIs occurring in the United States each year. SSIs can carry a notable burden for patients and physicians alike. Skin antiseptic solution plays an important role in preventing SSI. Many studies have looked at different skin antiseptic solution in preventing SSIs. Different surgical preps can decrease bacterial loads at surgical sites in varying degrees. Yet, the amount of bacterial load does not always correlate with a lower risk of infection.Chlorhexidine, for example, has been shown to cause markedly less SSIs compared with povidone-iodine prep in general surgery cases. Whereas chlorhexidine with alcohol may best work in the forefoot, iodine povacrylex with alcohol is equivalent in the spine. Conversely, joint arthroplasty SSIs were markedly decreased with a combination of preps. Because of all these differences, understanding which prep solution to use and when can be invalua...
Aesthetic surgery journal, 2017
Capsular contracture induced by chronic subclinical infection is a major cause of poor outcomes and reoperation in breast implant surgery. The use of pocket irrigation with antiseptic/antibiotic has been shown to reduce the incidence of contracture. A new formulation of hypochlorous acid solution PhaseOne has been proposed as potential agent for irrigation. This study aimed to test the efficacy of hypochlorous acid solution PhaseOne for use in breast pocket irrigation as an alternative to povidone iodine solution Betadine. The efficacy of PhaseOne, a hypochlorous acid formulated wound and skin cleanser, was tested in vitro against planktonic and biofilm Staphylococcus aureus with or without biological soil and in an implant attachment assay. Its activity was compared with Betadine containing 10% povidone iodine. Our findings showed that PhaseOne was unable to eradicate planktonic and/or biofilm S. aureus in the presence of either tryptone soy broth or bovine calf serum (protein soil...
Journal of Hospital Infection
Background: Cardiac implantable electronic device (CIED) infection, a major complication of a CIED implant procedure, can prolong hospitalization and cause mortality. Aim: To evaluate the efficacy of a bundled skin antiseptic preparation for preventing infection after implantation of a complex CIED. Methods: This study analysed 1163 consecutive patients who had received a bundled skin antiseptic preparation before CIED implantation from July 2012 to December 2017. According to the complexity of the CIED implant procedure, the patients were divided into a complex CIED group (N ¼ 370) and a non-complex CIED group (N ¼ 793). A complex procedure was defined as a pacemaker replacement, implantation of implantable cardioverter defibrillator and cardiac resynchronization therapy, device upgrade, or lead revision. Findings: During a mean follow-up of 2.9 AE 1.7 years, CIED infection developed in 15 patients (1.3%), and the incidence of minor and major infection was 1.1% and 0.2%, respectively. The incidence of CIED infection did not significantly differ between the complex CIED group and the non-complex CIED group (1.1% vs 1.4%, respectively; nonsignificant). Multivariate analysis indicated that procedural complexity was not an independent predictor of CIED infection. After 2:1 propensity score matching, the matched non-complex CIED group and the matched complex CIED group still showed no significant difference in the incidence of CIED infection. Conclusion: Bundled skin antiseptic preparation is an effective and widely applicable strategy for decreasing infection risk after a complex CIED implantation.
The Journal of Urology, 2013
We defined the relevant skin flora during genitourinary prosthetic surgery, evaluated the safety of chlorhexidine-alcohol for use on the male genitalia and compared chlorhexidine-alcohol to povidone-iodine in decreasing the rate of positive bacterial skin cultures at the surgical skin site before prosthetic device implantation. Materials and Methods: In this single institution, prospective, randomized, controlled study we evaluated 100 consecutive patients undergoing initial genitourinary prosthetic implantation. Patients were randomized to a standard skin preparation with povidone-iodine or chlorhexidine-alcohol. Skin cultures were obtained from the surgical site before and after skin preparation. Results: A total of 100 patients were randomized, with 50 in each arm. Prepreparation cultures were positive in 79% of the patients. Post-preparation cultures were positive in 8% in the chlorhexidine-alcohol group compared to 32% in the povidone-iodine group (p ϭ 0.0091). Coagulase-negative staphylococci were the most commonly isolated organisms in post-preparation cultures in the povidone-iodine group (13 of 16 patients) as opposed to propionibacterium in the chlorhexidine-alcohol group (3 of 4 patients). Clinical complications requiring additional operations or device removal occurred in 6 patients (6%) with no significant difference between the 2 groups. No urethral or genital skin complications occurred in either group. Conclusions: Chlorhexidine-alcohol was superior to povidone-iodine in eradicating skin flora at the surgical skin site before genitourinary prosthetic implantation. There does not appear to be any increased risk of urethral or genital skin irritation with the use of chlorhexidine compared to povidone-iodine. Chlorhexidine-alcohol appears to be the optimal agent for skin preparation before genitourinary prosthetic procedures.
Journal of Innovative Science, 2020
One of the major causes of surgical site infection (SSI) is an inappropriate surgical site preparation that leads to postoperative complications. Although preoperative skin preparation is a standard surgical practice to prevent SSI, the choice of skin disinfectants and methods of skin preparation is still aberrant in veterinary practice. The study was, thus, conducted to standardize pre-surgical skin preparation with various formulations of Chlorhexidine gluconate, Chlorxylenol, and Povidone-iodine (PI) in goat. Seven surgical fields were prepared for evaluating seven formulations of these antiseptics. The bacterial swabs collected at different stages of skin preparations were transferred in nutrient broth and cultured in Plate Count Agar for counting of Colony Forming Unit (CFU). Results revealed that Chlorxylenol was less efficacious than PI and Chlorhexidine gluconate when mean CFU was counted at different stages of surgical field preparation. Soap water scrubbing and ethanol spray followed by aqueous Chlorhexidine gluconate painting eliminated 100% bacterial load and kept the site aseptic for 60 min. On the other hand, alcoholic Chlorhexidine gluconate completely removed bacterial burden from the skin and maintained 90 min long aseptic condition of the operation site. Based on our findings, alcoholic Chlorhexidine gluconate was the best in producing an aseptic surgical field for a longer duration. Our findings recommend robust scrubbing of the surgical site with detergent or soap water followed by 70% ethanol or hexisol spray and then painting the site with antiseptic preferably with alcoholic Chlorhexidine gluconate solution to generate aseptic surgical site which is very basic to prevent SSI and postoperative complications.
BJS Open, 2019
Background: Surgical-site infection (SSI) is a serious surgical complication that can be prevented by preoperative skin disinfection. In Western European countries, preoperative disinfection is commonly performed with either chlorhexidine or iodine in an alcohol-based solution. This study aimed to investigate whether there is superiority of chlorhexidine-alcohol over iodine-alcohol for preventing SSI. Methods: This prospective cluster-randomized crossover trial was conducted in five teaching hospitals. All patients who underwent breast, vascular, colorectal, gallbladder or orthopaedic surgery between July 2013 and June 2015 were included. SSI data were reported routinely to the Dutch National Nosocomial Surveillance Network (PREZIES). Participating hospitals were assigned randomly to perform preoperative skin disinfection using either chlorhexidine-alcohol (0⋅5 per cent/70 per cent) or iodine-alcohol (1 per cent/70 per cent) for the first 3 months of the study; every 3 months thereafter, they switched to using the other antiseptic agent, for a total of 2 years. The primary endpoint was the development of SSI. Results: A total of 3665 patients were included; 1835 and 1830 of these patients received preoperative skin disinfection with chlorhexidine-alcohol or iodine-alcohol respectively. The overall incidence of SSI was 3⋅8 per cent among patients in the chlorhexidine-alcohol group and 4⋅0 per cent among those in the iodine-alcohol group (odds ratio 0⋅96, 95 per cent c.i. 0⋅69 to 1⋅35). Conclusion: Preoperative skin disinfection with chlorhexidine-alcohol is similar to that for iodine-alcohol with respect to reducing the risk of developing an SSI.