Surgical site infections

1. “CLINICAL EVALUATION OF PREOPERATIVE SKIN PREPARATION WITH
AQUEOUS POVIDONE IODINE ALONE AND IN COMBINATION WITH
ALCOHOLIC CHLORHEXIDINE IN PATIENTS UNDERGOING ELECTIVE
SURGERY ”
Dr Nihal S Kiran, Dr AY
Kshirsagar
Dept of Surgery
KIMSH

2. Introduction
• In spite of the fact that the risk of surgery site infections (SSI) in clean surgical cases is modest, ranging from
0.3% to 1.9%, the implications of these infections, particularly deep infections, are devastating for patients
who are otherwise healthy.
• The patient's own natural skin flora, not contamination from equipment or the air in the room, is the primary
cause of surgical site infections (SSIs).
• It has been shown that degerming the skin with antiseptics for a duration of less than one minute is just as
effective as scrubbing the skin for five minutes with a germicidal soap solution and then painting on
antiseptics
• The recommendation to use an alcohol-based antiseptic agent is supported by the 2017 CDC Guideline for the
Prevention of SSIs. CHX is recommended for usage by a variety of other organisations, including the
Canadian Patient Safety Institute and the Health Protection Scotland [5, 6]. The remanent impact against
bacterial regrowth and the consequent extended action that may be ascribed to CHX are the basis for these
recommendations [7,8]. In addition, in contrast to iodophors, CHX does not lose its active state in the
presence of organic fluids like blood or pus [9], while these substances cause iodophors to lose their activity.

3. AIM:
• To evaluate efficacy of Preoperative skin preparation with aqueous povidone-
iodine alone and in combination with alcoholic chlorhexidine in individuals having
elective surgery.
OBJECTIVES:
 To determine incidence of surgical site infection in elective surgical cases
 To compare efficacy of povidone iodine vs chlorhexidine in preventing surgical site infections

4. OBJECTIVES:
 To determine incidence of surgical site infection in elective surgical cases
 To compare efficacy of povidone iodine vs chlorhexidine in preventing surgical site infections

5. Study Design
• Type Of Study: observational prospective study
INCLUSION CRITERIA:
• All patients aged more than 18 years, undergoing clean elective surgery
were enrolled
EXCLUSION CRITERIA:
• Patients of immunocompromised state
• Patients on long-term steroids.
• Patients with septicemic foci at the time of admission.

6. Methodology
• The cases were chosen at random,
• preoperative parts preparation done.
• Patients divided into 2 groups
 Group-1 three coatings of aqueous povidone-iodine IP 5% w/v.
 Group-2 single coat of an agent that contains chlorhexidine gluconate 2.5% v/v in 70% propanol. f/b two coats of
aqueous povidone-iodine IP 5% w/v.
• Inj Cefotaxime, 1 Gm administered as a pre-op antibiotic one hour before the incision is made.
• The site of the incision is promptly swabbed with sterile saline and subjected to culture and sensitivity testing.
• patient were routinely inspected for a period of 10 days post-op until suture removal

7. Results
0
5
10
15
20
25
30
35
Excision Excision Biopsy Hemithyroidectomy Hernioplasty Superficial
Parotidectomy
Total
Thyroidectomy
appendectomy
Patient Distribution
Group I Group II

8. Results
Microbiological report
Group I Group II
No infection Infection Total No infection Infection Total
No Growth 57 4 61 68 1 69
Growth 4 5 9 1 0 1
Total 61 9 70 69 1 70
Culture
Group I
Group
II
Total
N=70 % N=70 % N=140 %
Negative 61 87.14 69 98.57 130 92.86
Positive 9 12.86 1 1.43 10 7.14
Relationship between Microbiological report
and post-operative wound infection rate
Comparison b/w Culture report of both
groups

9. Discussion
• Even after skin disinfection, the colonisation of the site of incision was observed in 12.86% of participants in
group-1 and 1.43% of participants in group-2. Comparatively, the respective values in Julia L et al. [10] studies
were 35.3% and 4.7%, and in Ajay et al. [11] studies they were 20.8% and 3.3%. This demonstrates that the
colonisation rates of the sites of incision were greatly decreased when using a combination of povidone-iodine
and an alcoholic solution of chlorhexidine as opposed to only using povidone-iodine alone. This was compared
to using povidone-iodine alone.
• The incidence of postoperative wound infections in group-1 is 7.14 percent, while the rate in group-2 is zero
percent, but the comparable values in studies conducted by Brown et al. [12] emphasising the importance of
using dual antiseptics for skin preparation

10. Conclusion
• The results of this study demonstrate that povidone-iodine in combination with alcoholic chlorhexidine is more
effective in pre-operative skin preparation than povidone-iodine used alone.
• This combination should be recommended as the antiseptic of choice for use in skin preparation prior to elective
clean surgery.
• It is appropriate to follow this regimen in contaminated and emergency operations given that it was shown to be
superior in reducing incision site colonisation and postoperative wound infection.

11. BIBLIOGRAPHY
1. Yamakado K. Propionibacterium acnes suture contamination in arthroscopic rotator cuff repair: a prospective randomized study.
Arthrosc. J. Arthrosc. Relat. Surg. 2018;34:1151– 1155. doi: 10.1016/j.arthro.2017.10.029.
2. Savage JW, et al. Efficacy of surgical preparation solutions in lumbar spine surgery. J. Bone Jt. Surg. 2012;94:490–494. doi:
10.2106/JBJS.K.00471..
3. Richard Howard J. “Surgical infections.” Schwartz textbook of principles of surgery, McGraw Hill Company, 7th international edition 1999, 132.
4. Berrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention guideline for the
prevention of surgical site infection, 2017. JAMA Surg 2017;152:784-791.
5. Ritter B, Herlyn PKE, Mittlmeier T, Herlyn A. Preoperative skin antisepsis using chlorhexidine may reduce surgical wound infections
in lower limb trauma surgery when compared to povidone-iodine—A prospective randomized trial. Am. J. Infect. Control.
2020;48:167–172
6. Blonna D, et al. Single versus double skin preparation for infection prevention in proximal humeral fracture surgery. Biomed. Res. Int.
2018;2018:1–7. doi: 10.1155/2018/8509527.
7. Leaper D, Burman-Roy S, Palanca A, Cullen K, Worster D, Gautam-Aitken E, et al. Prevention and treatment of surgical site infection: summary
of NICE guidance. BMJ 2008;337:a1924.
8. Anon. Prävention postoperativer Wundinfektionen. Bundesgesundheitsblatt GesundheitsforschungGesundheitsschutz 2018;61:448-473.
9. Lim KS, Kam PC. Chlorhexidine–pharmacology and clinical applications. Anaesth Intensive Care 2008;36:502- 512.

12. THANK YOU