Antisepsis Techniques in Orthopedic Surgical Procedures: A Comparative Study^[*]

Abstract

Objective To compare antisepsis techniques using chlorhexidine-based soap associated with ethyl alcohol and alcohol-based chlorhexidine or chlorhexidine-based soap associated with alcohol-based chlorhexidine alone in surgical orthopedic procedures.

Methods This is a primary, randomized, analytical and single-center clinical trial consisting of 170 patients, who were divided into 2 groups. The combinations chlorhexidine-based soap + alcohol-based chlorhexidine (CSAC) and chlorhexidine-based soap + 70% ethyl alcohol + alcohol-based chlorhexidine (CSAAC) were tested in each group. The cultures were grown in mannitol and eosin methylene blue (EMB) after collection before skin preparation (time point 0), after skin preparation (time point 1) and at the end of the surgical procedure (time point 2).

Results There was no statistically significant difference regarding bacterial growth in mannitol and EMB between the groups at any time point. Moreover, there was no statistical difference between groups and time points regarding the type of bacterial growth in culture media.

Conclusion There was no difference between these antisepsis techniques for the prevention of surgical site infection in orthopedic procedures; in addition, a protocol containing measures to prevent infection in such procedures was developed.

Keywords

chlorhexidine - infection - orthopedics - operating rooms - antisepsis - surgical procedures

^* Study performed at Hospital das Clínicas Samuel Libânio, Pouso Alegre, MG, Brazil.

• Referências

• 1 Savage JW, Anderson PA. An update on modifiable factors to reduce the risk of surgical site infections. Spine J 2013; 13 (09) 1017-1029
• 2 Brasil. Ministério da Saúde. Sítio cirúrgico: critérios nacionais de Infecções relacionadas à assistência à saúde [acesso em 2017 abr. 10]. Brasília: Agência Nacional de Vigilância Sanitária; 2009 . Disponível em: http://www.anvisa.gov.br/servicosaude/manuais/criterios_nacionais_ISC.pdf
• 3 Brasil. Ministério da Saúde. Medidas de prevenção de infecção relacionada à assistência à saúde [acesso em 2017 abr. 10]. Brasília: Agência Nacional de Vigilância Sanitária; 2017. . Disponível em: http://portal.anvisa.gov.br/documents/33852/3507912/Caderno+4+-+Medidas+de+Preven%C3%A7%C3%A3o+de+Infec%C3%A7%C3%A3o+Relacionada+%C3%A0+Assist%C3%AAncia+%C3%A0+Sa%C3%BAde/a3f23dfb-2c54-4e64-881c-fccf9220c373
• 4 Saldmann F. On s'en lave les mains. Tout connaître des nouvelles règles de l'hygiène. Paris: Flammarion; 2007
• 5 Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol 2010; 31 (12) 1219-1229
• 6 Mears SC, Dinah AF, Knight TA, Frassica FJ, Belkoff SM. Visibility of surgical site marking after preoperative skin preparation. Eplasty 2008; 8: e35
• 7 Swenson BR, Hedrick TL, Metzger R, Bonatti H, Pruett TL, Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infect Control Hosp Epidemiol 2009; 30 (10) 964-971
• 8 Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am 2009; 91 (08) 1949-1953
• 9 Reichel M, Heisig P, Kohlmann T, Kampf G. Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob Agents Chemother 2009; 53 (11) 4778-4782
• 10 Widerström M. Significance of Staphylococcus epidermidis in Health Care-Associated Infections, from Contaminant to Clinically Relevant Pathogen: This Is a Wake-Up Call!. J Clin Microbiol 2016; 54 (07) 1679-1681
• 11 Martínez J, Macías JH, Arreguín V, Álvarez JA, Macías AE, Mosqueda-Gómez JL. Isopropyl alcohol is as efficient as chlorhexidine to prevent contamination of blood cultures. Am J Infect Control 2017; 45 (04) 350-353
• 12 Mimoz O, Chopra V, Timsit JF. What's new in catheter-related infection: skin cleansing and skin antisepsis. Intensive Care Med 2016; 42 (11) 1784-1786