Arch Hand Microsurg.  2022 Jun;27(2):119-124. 10.12790/ahm.21.0151.

The role of skin antisepsis in upper extremity surgery to reduce surgical site infection: a comparison between single and triple regimens

• Hwang JS
• Lee DM
• Lee YH

• KMID: 2531917
• DOI: http://doi.org/10.12790/ahm.21.0151

Abstract

Purpose
No consensus exits regarding preoperative skin antisepsis for upper extremity surgery. We aimed to determine whether the use of povidone-iodine only (single regimen) instead of povidone-iodine and alcohol-chlorhexidine (triple regimen) resulted in an increased rate of surgical site infection (SSI), and to detect any associated factors that increased the infection risk.
Methods
A cross-sectional, retrospective review of medical records was conducted for patients who underwent upper extremity surgery from March 2020 to February 2021. Either the single or triple regimen was used for preoperative skin antisepsis. The rate of SSI was compared based on a marked elevation of C-reactive protein (CRP) at 2 weeks after surgery, superficial SSI, and deep SSI. Logistic regression analysis was performed to identify factors associated with SSI among the evaluated parameters.
Results
Among 175 patients (male, 81 and female, 94), the single regimen was used in 78 patients (44.6%) and the triple regimen in 97 patients (55.4%). The single regimen (odds ratio [OR], 2.425; 95% confidence interval [CI], 1.040–5.655) and a surgical procedure using a metal implant (OR, 3.602; 95% CI, 1.184–10.953) were significantly associated with a marked CRP elevation at 2 weeks. However, there was no difference in SSI rates between the single and triple regimens. Diabetes mellitus (OR, 6.636; 95% CI, 1.259–34.969) was the only factor significantly associated with superficial SSI through logistic regression analysis.
Conclusion
Our study suggests that the single regimen resulted in a longer CRP elevation than the triple regimen, but was similarly effective in preventing SSI for upper extremity surgery.

Keyword

Skin antisepsis; Povidone-iodine; Surgical site infection

Reference

References

1. Lee J, Singletary R, Schmader K, Anderson DJ, Bolognesi M, Kaye KS. Surgical site infection in the elderly following orthopaedic surgery: risk factors and outcomes. J Bone Joint Surg Am. 2006; 88:1705–12.

2. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008; 466:1710–5.

3. Haley RW, Schaberg DR, Crossley KB, Von Allmen SD, McGowan JE Jr. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med. 1981; 70:51–8.

4. Coello R, Glenister H, Fereres J, et al. The cost of infection in surgical patients: a case-control study. J Hosp Infect. 1993; 25:239–50.

5. Wenzel RP. The Lowbury lecture: the economics of nosocomial infections. J Hosp Infect. 1995; 31:79–87.

6. Mastrocola M, Matziolis G, Böhle S, Lindemann C, Schlattmann P, Eijer H. Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery. Sci Rep. 2021; 11:18634.

7. Meakins JL, Masterson BJ. Epidemiology of surgical site infection. In : Souba WW, Fink MP, Jurkovich GJ, editors. ACS surgery: principles and practice. New York: WebMD Inc;2004. p. 17–36.

8. Zdeblick TA, Lederman MM, Jacobs MR, Marcus RE. Preoperative use of povidone-iodine: a prospective, randomized study. Clin Orthop Relat Res. 1986; (213):211–5.

9. Letzelter J, Hill JB, Hacquebord J. An overview of skin antiseptics used in orthopaedic surgery procedures. J Am Acad Orthop Surg. 2019; 27:599–606.

10. Ellenhorn JD, Smith DD, Schwarz RE, et al. Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites. J Am Coll Surg. 2005; 201:737–41.

11. Welsch T, Müller SA, Ulrich A, et al. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis. 2007; 22:1499–507.

12. Centers for Disease Control and Prevention (CDC). National Healthcare Safety Network: surgical site infection event [Internet]. Atlanta, GA: CDC;2022. [cited 2021 Dec 8]. Available from: http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf.

13. Ryan DJ, Minhas SV, Konda S, Catalano LW. Surgical site infection after open upper extremity fracture and the effect of urgent operative intervention. J Orthop Trauma. 2020; 34:258–62.

14. Greenblatt DY, Rajamanickam V, Mell MW. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg. 2011; 54:433–9.

15. Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect. 2006; 63:255–62.

16. Barreto R, Barrois B, Lambert J, Malhotra-Kumar S, Santos-Fernandes V, Monstrey S. Addressing the challenges in antisepsis: focus on povidone iodine. Int J Antimicrob Agents. 2020; 56:106064.

17. Peterson AF, Rosenberg A, Alatary SD. Comparative evaluation of surgical scrub preparations. Surg Gynecol Obstet. 1978; 146:63–5.

18. Privitera GP, Costa AL, Brusaferro S, et al. Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: a systematic review and meta-analysis. Am J Infect Control. 2017; 45:180–9.