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Carola F Eck, Julie A Neumann, Orr Limpisvasti, Christopher R Adams
PURPOSE: Infection is a concern after all orthopedic procedures, including shoulder surgery. This systematic review of literature aimed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery. METHODS: An electronic database search was performed using MEDLINE (1950-October 2017), EMBASE (1980-October 2017), CINAHL (1982-October 2017), and the Cochrane database to identify studies reporting a risk factor or preventive measure for infection after shoulder surgery...
January 16, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Shahzad G Raja, Melissa Rochon, Clair Mullins, Carlos Morais, Antonios Kourliouros, Ellie Wishart, Anthony De Souza, Sunil Bhudia
Background: Antiseptic skin preparations containing chlorhexidine gluconate and povidone iodine are routinely used to reduce the risk of surgical site infection (SSI). This study assesses the efficacy of two alcohol-based solutions, 2% chlorhexidine-alcohol and 10% povidone iodine-alcohol, on the incidence of cardiac SSI. Methods: A total of 738 consecutive patients undergoing cardiac surgery had skin preparation with 2% chlorhexidine gluconate in 70% isopropanol (ChloraPrep, BD Ltd, UK) were propensity matched to 738 patients with skin prepared with 10% povidone-iodine in 30% industrial methylated spirit (Videne Alcoholic Tincture, Ecolab Ltd, UK)...
January 2018: Journal of Infection Prevention
George M Ghobrial, Michael Y Wang, Barth A Green, Howard B Levene, Glen Manzano, Steven Vanni, Robert M Starke, George Jimsheleishvili, Kenneth M Crandall, Marina Dididze, Allan D Levi
OBJECTIVE The aim of this study was to determine the efficacy of 2 common preoperative surgical skin antiseptic agents, ChloraPrep and Betadine, in the reduction of postoperative surgical site infection (SSI) in spinal surgery procedures. METHODS Two preoperative surgical skin antiseptic agents-ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol) and Betadine (7.5% povidone-iodine solution)-were prospectively compared across 2 consecutive time periods for all consecutive adult neurosurgical spine patients...
February 2018: Journal of Neurosurgery. Spine
S Patrick, A McDowell, A Lee, A Frau, U Martin, E Gardner, G McLorinan, N Eames
AIMS: The aim of this study was to determine whether the sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in patients undergoing spinal surgery. PATIENTS AND METHODS: A single-centre, interventional, two arm, parallel group randomised controlled trial was undertaken, involving 407 patients who underwent elective spinal surgery...
October 2017: Bone & Joint Journal
Sameer Bahal, Samriti Sharma, Lene Heise Garvey, Vasantha Nagendran
A 54-year-old man with end-stage renal failure attended for dialysis. Within seconds of applying 2% w/v chlorhexidine (ChloraPrep 3 mL Wand Applicator) to the skin surrounding the insertion point of his dialysis catheter (Tesio catheter), he developed pruritus, urticaria, shortness of breath, hypotension and reduced responsiveness. Treatment for anaphylaxis was initiated with rapid improvement of his symptoms, and he made a full recovery. Allergy to chlorhexidine was confirmed with skin testing, and the patient was warned against all future exposure to chlorhexidine...
August 8, 2017: BMJ Case Reports
Claudia I Martinez, Stephen Fletcher, Manish N Shah, Marcia L Kerr, David I Sandberg
AIMS: This study assessed variations in pediatric neurosurgical technique when accessing shunts and ventricular access devices (VADs). METHODS: A 12-question survey was developed and sent to members of the American Association of Neurological Surgeons (AANS) whose self-identified subspecialty was pediatric neurosurgery. RESULTS: Four hundred and twenty surveys were sent out, and 149 responses were received (35.5% response rate); 95.3% of respondents always use sterile gloves, 55...
2017: Pediatric Neurosurgery
Peter Z Xu, John R Fowler, Robert J Goitz
BACKGROUND: Decontamination of the skin prior to incision is part of the standard of care for any surgical procedure. Previous studies have demonstrated variable efficacy of different surgical preparation solutions based on anatomic location. The purpose of this study is to determine the effectiveness of 3 commonly used surgical preparation solutions in eliminating bacteria from the skin prior to incision for common elective soft tissue hand procedures. METHODS: A total of 240 patients undergoing clean, elective, soft tissue hand surgery were prospectively randomized to 1 of 3 groups (ChloraPrep, DuraPrep, or Betadine)...
May 2017: Hand: Official Journal of the American Association for Hand Surgery
Claire M McDaniel, Ryan W Churchill, Evan Argintar
Preoperative skin preparation with antimicrobial agents decreases the risk of surgical site infection, but concerns have been raised about the visibility of a common surgical preparatory agent (ChloraPrep; Becton, Dickinson & Co, Franklin Lakes, New Jersey), depending on skin pigmentation. Poor visibility may lead to failure to identify inadequately prepared skin, increasing the risk of surgical site infection. This study was conducted to determine whether different tints of ChloraPrep and different skin pigmentations affect the ability of orthopedic surgeons to identify the adequacy of skin preparation...
January 1, 2017: Orthopedics
David Hardeski, Greg Gaski, Manjari Joshi, Richard Venezia, Jason W Nascone, Marcus F Sciadini, Robert V O'Toole
BACKGROUND: Temporary external fixators are often used to stabilize fractures when definitive fracture surgery must be delayed. Sometimes, external fixators are left in place during repeat operations, including definitive internal fixation of tibial pilon and tibial plateau fractures. It is unknown how well current surgical preparation sterilizes these devices, which become part of the surgical field. Our hypothesis was that our institution's standard surgical preparation creates a low rate of culture-positive environments on external fixators at the time of surgical skin incision...
December 2016: Injury
Tomas Madej, Katrin Plötze, Christin Birkner, Lutz Jatzwauk, Matschke Klaus, Thomas Waldow
BACKGROUND: Reducing surgical site infections (SSI) following median sternotomy remains a challenge for cardiac surgeons. Standard prophylaxis of SSI at our institution includes pre-operative skin disinfection with isopropyl alcohol (IPA). The addition of chlorhexidine gluconate (CHG) has the theoretical advantage of longer antimicrobial activity (>48h), compared with 2 h for IPA alone. OBJECTIVES: This prospective registry study was conducted to evaluate the effect of combined CHG-IPA (ChloraPrep®) skin antiseptic on the incidence of sternal surgical incision infections after cardiac surgical procedures via median sternotomy...
October 2016: Surgical Infections
Daniel A Seigerman, Michael Rivlin, Justin Bianchini, Frederick E Liss, Pedro K Beredjiklian
PURPOSE: The purpose of this study was to determine the extent of skin coverage during surgical preparation of the hand when preparation is done by 2 different methods. We hypothesized that hand preparation with commercially available prep-stick applicators (PS) would lead to more unprepared areas (UPAs) of skin compared with immersed 4 × 4 inch sterile gauze sponges (GS) used as controls. METHODS: Sixty upper extremities of 30 healthy volunteers were used for this study...
June 2016: Journal of Hand Surgery
M Doorly, J Choi, A Floyd, A Senagore
BACKGROUND: Surgical site infections (SSI) are costly complications that may cause significant morbidity and increase the cost of care, particularly in colorectal surgery. Microbial sealants (MS) are a new class of wound barriers aimed at decreasing SSI; however, there is only evidence of benefit in clean class 1 procedures. Based on its success in class 1 procedures, we hypothesized that a microbial sealant could reduce the rate of SSI by half for clean-contaminated colorectal procedures (class 2)...
May 2015: Techniques in Coloproctology
Eric Boe, Hugo B Sanchez, Faustino M Kazenske, Russell A Wagner
The solution of 2% chlorhexidine gluconate and 70% isopropyl alcohol (Chloraprep) is commonly used for antiseptic skin preparation before surgery. We conducted a study to evaluate the efficacy of this solution in eradicating organisms during skin preparation for total knee arthroplasty (TKA), to isolate the organism type, and to evaluate possible contributing factors leading to infection. Ninety-nine patients who were undergoing TKA were swabbed for cultures in the popliteal fossa before and after solution application...
December 2014: American Journal of Orthopedics
Michael J Lee, Paul S Pottinger, Susan Butler-Wu, Roger E Bumgarner, Stacy M Russ, Frederick A Matsen
BACKGROUND: Propionibacterium acnes, which normally resides in the skin, is known to play a role in surgical site infection in orthopaedic surgery. Studies have suggested a persistence of propionibacteria on the skin surface, with rates of positive cultures ranging from 7% to 29% after surgical preparation. However, as Propionibacterium organisms normally reside in the dermal layer, these studies may underestimate the true prevalence of propionibacteria after surgical skin preparation...
September 3, 2014: Journal of Bone and Joint Surgery. American Volume
S Magalini, G Pepe, S Panunzi, A De Gaetano, C Abatini, A Di Giorgio, M Foco, D Gui
BACKGROUND AND OBJECTIVES: Surgical site infection (SSI) rate is reported to range around 16%. Preoperative skin disinfection is keystone for SSI reduction. Chlorhexidine-alcohol has been reported to be more effective than Povidone-iodine (PVI). However, in many countries established habits and the inferior costs of PVI restrain the employment of chlorhexidine disinfection kits (ChloraPrep®) for the preparation of the surgical field. MATERIALS AND METHODS: The costs of surgical field preparation in clean-contaminated surgery utilizing PVI (Betadine) and chlorhexidine alcohol and the evaluation of surgeon compliance and satisfaction, were studied by a observational study on 50 surgical operations in which surgical field was prepared with PVI checking established guidelines, and on 50 surgical operations in which chlorhexidine-alcohol (ChloraPrep) was employed...
December 2013: European Review for Medical and Pharmacological Sciences
Suzanne Corcoran, Valerie Jackson, Sam Coulter-Smith, John Loughrey, Peter McKenna, Mary Cafferkey
BACKGROUND: Surgical site infection (SSI) is an important complication of cesarean section (CS) delivery and a key quality indicator of patient care. METHODS: A baseline assessment was undertaken to determine SSI rates, and subsequently a quality improvement program was introduced, followed by repeat surveillance. Data were collected during in-hospital stays and for up to 30 days after CS during both periods. Interventions in the quality improvement program included the use of nonabsorbable sutures for skin closure, use of clippers instead of razors, and use of 2% ChloraPrep for skin disinfection before incision...
December 2013: American Journal of Infection Control
Gary L Grove, Chou I Eyberg
BACKGROUND: Adhesion of incise drapes is important at the wound edge, where the skin and drapes are contiguous with the wound. Separation of incise drapes from the skin has been reported to be associated with a sixfold increase in the infection rate compared with surgical procedures in which the drape did not lift off. The present study sought to determine whether the choice of preoperative skin preparation affects the adhesion of various incise drapes. METHODS: Following randomization, the backs of twenty-two healthy volunteers were prepared with two skin preparations, 3M DuraPrep Surgical Solution Patient Preoperative Skin Preparation or ChloraPrep with Tint (Scrub Teal) Patient Preoperative Skin Preparation, according to the label directions...
July 3, 2012: Journal of Bone and Joint Surgery. American Volume
Thomas H Sanders, Samuel M Hawken
Chlorhexidine is an antiseptic and disinfectant commonly used for surgical site preparation and cleansing. It is active against a broad spectrum of bacteria, viruses, mycobacteria, and fungi. We report 3 cases of patients with superficial partial thickness burns immediately following shoulder arthroscopic surgery with the use of a Chloraprep 26 mL applicator (2% chlorhexidine gluconate and 70% isopropyl alcohol; CareFusion, Leawood, Kansas). All 3 patients reported pain as the anesthetic waned at a localized area on the anterior arm near the axilla...
April 2012: American Journal of Orthopedics
Jason W Savage, Brian M Weatherford, Patrick A Sugrue, Mark T Nolden, John C Liu, John K Song, Michael H Haak
BACKGROUND: Postoperative spinal wound infections are relatively common and are often associated with increased morbidity and poor long-term patient outcomes. The purposes of this study were to identify the common bacterial flora on the skin overlying the lumbar spine and evaluate the efficacy of readily available skin-preparation solutions in the elimination of bacterial pathogens from the surgical site following skin preparation. METHODS: A prospective randomized study was undertaken to evaluate 100 consecutive patients undergoing elective lumbar spine surgery...
March 21, 2012: Journal of Bone and Joint Surgery. American Volume
Michael T Adler, Kristin R Brigger, Karen D Bishop, Joan M Mastrobattista
OBJECTIVE: To compare the bactericidal properties of povidone-iodine versus alcohol-based chlorhexidine solution for cleansing the gravid abdomen prior to amniocentesis. METHODS: Fifty study participants were recruited from the University of Texas Women's Clinic in Houston, Texas. Two baseline swabs of the patients' abdomens were obtained to assess bacterial flora prior to treatment. A 10% povidone-iodine solution and 2% chlorhexidine gluconate with 70% isopropyl alcohol solution in a 3-mL prefilled applicator (Chloraprep, Cardinal Health, Inc...
June 2012: American Journal of Perinatology
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