povidone-iodine and Hernia--Inguinal

Most surgical site infections (SSIs) are caused by the patient's endogenous flora, and hence strategies to prevent bacterial contamination of the surgical incision have a central role in the prevention of such infections. However, even with optimal skin preparation, true sterilisation of the skin is not possible. A recently available method of preventing infection is a cyanoacrylate-based microbial sealant (marketed as InteguSeal(*) Microbial Sealant), which mechanically blocks migration of pathogens to the surgical wound. In in-vitro studies, this preoperative preparation reduced the recovery of pathogens commonly implicated in SSIs by up to 99.9%. Similarly, the incidence of wound contamination was lower with the microbial sealant than with antimicrobial surgical drapes in in-vivo studies. Other studies have shown that this microbial sealant significantly improves the effect of povidone iodine by fixing it on the skin and avoiding wash off, and does not affect normal skin transpiration. In a clinical study in 177 patients, the incidence of wound contamination was 53.0% with the sealant, compared with 68.7% using povidone iodine. The conclusion of this clinical study is that InteguSeal(*) Microbial Sealant significantly reduces surgical wound bacterial contamination when used in conjunction with 10% povidone iodine skin preparation, as compared to povidone iodine alone. The clinical experience to date is that this sealant is easy to apply and can be used with a variety of skin preparation solutions and with most wound closure techniques. It also has a good safety profile. This preparation may therefore form a valuable part of strategies to reduce bacterial contamination of surgical incisions, thereby potentially decreasing the risk of SSIs.

Topics: Animals; Anti-Infective Agents, Local; Cyanoacrylates; Hernia, Inguinal; Humans; Povidone-Iodine; Preoperative Care; Randomized Controlled Trials as Topic; Skin; Surgical Wound Infection; Swine

The risk of wound infection after elective inguinal hernia repair depends on several factors. One of the most important factors is the preoperative skin preparation. The use of antisepsis is performed to reduce the risk of surgical site infections (SSIs) and to remove causing organisms. This work compares two different agent forms for preoperative skin preparation to prevent SSIs.. The objective of the study is comparing the effects of two different agents used for preoperative skin preparation and prevention of SSIs.. 100 adult patients were divided and randomized into two groups, each containing 50 patients. Both groups included patients that are scheduled for elective Lichtenstein inguinal hernia repair. The first group includes patients whose skin preparations were done with povidone iodine (PI) only. The second group included patients that are treated with two antiseptics; Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide. Alkosol is applied before the induction of anesthesia. The povidone iodide is applied after Alkosol has evaporated. The presence of bacterial growth in the wound was determined 24 and 48 hours after operation. Swabs were used to take samples, which were then cultivated to check for bacterial growth. The presence of infection was also determined by the following criteria: pain or tenderness, induration, erythema, local warmth of the wound etc.. The surgeon or clinician declared that after 24 hours the wound was infected in 20 patients in the control group and in 22 patients after 48 hours. In the Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide group infection was declared in only 3 patients after 24 hours.. Compared to the use of providone only, the use of Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide has many advantages and was associated with lower rates of SSIs following clean surgery. A larger trial is warranted in order to add definitive and more conclusive data to the current evidence base.

Topics: 2-Propanol; Adolescent; Adult; Aged; Anti-Infective Agents, Local; Ethanol; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Incidence; Male; Middle Aged; Povidone-Iodine; Preoperative Care; Prospective Studies; Surgical Wound Infection; Treatment Outcome; Young Adult

Application of skin sealant prior to incision reduces microbial contamination of the wound.. Prospective, randomized, multicenter clinical trial.. Six teaching hospitals.. A total of 177 adult patients undergoing elective open inguinal hernia repair were randomized to either standard skin preparation with 10% povidone-iodine or skin preparation followed by cyanoacrylate-based liquid microbial sealant.. Wound contamination was assessed during surgery by microbial sampling inside the wound at initiation of skin incision and prior to skin closure.. The primary outcome measures were the safety and effectiveness of cyanoacrylate-based microbial sealant to reduce bacterial contamination during surgery. The secondary outcome measure was reduction of postoperative surgical site infections using microbial sealant.. Demographics were similar. Patients treated with sealant were more likely to have no bacterial cells found in the wound than control participants (47% vs 31%; P = .04). Three patients developed surgical site infections; all were in the control group (P = .25). Independent factors that reduced wound contamination were use of microbial sealant (odds ratio, 0.45; confidence interval, 0.23-0.88; P = .02) and perioperative antibiotics (odds ratio, 0.24; confidence interval, 0.10-0.58; P = .001).. Cyanoacrylate-based microbial sealant may be an important tool to reduce wound contamination and potentially prevent surgical site infections.

Topics: Adult; Aged; Anti-Infective Agents, Local; Cyanoacrylates; Female; Hernia, Inguinal; Humans; Logistic Models; Male; Methicillin Resistance; Middle Aged; Patient Selection; Povidone-Iodine; Prospective Studies; Skin; Staphylococcus aureus; Surgical Wound Infection

Povidone-iodine (PI) is a scarce and expensive item for some hospitals in developing countries. This prospective, randomized study was performed at Baptist Medical Centre (BMCO) in Ogbomoso, Nigeria to determine if the use of PI for preoperative skin preparation would result in a lower postoperative wound infection rate and to identify other factors influencing the infection rate. Two hundred patients undergoing inguinal hernia repair were randomized to receive skin preparation with either: (1) locally available, inexpensive market soap and methylated spirit or (2) imported PI. The two groups were equally stratified. The overall postoperative wound infection rate was 5.5%, and there was no significant difference between the groups (5.1% vs. 5.9%). Factors that did not affect the infection rate included gender, age, type of anesthesia, type or duration of the operative procedure, and number of breaks in optimal technique. There were eight abscesses and three cases of cellulitis without suppuration diagnosed an average of 10 days postoperatively. Staphylococcus was the only bacterium identified on Gram stain or culture. The expense of procuring PI is not justified at BMCO. Available funds may better be used for preoperative antibiotics or for improvement in hospital infrastructure, which should result in fewer breaks in optimal operating room technique.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Child; Child, Preschool; Female; Hernia, Inguinal; Humans; Infant; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Soaps; Surgical Wound Infection

In a prospective randomized trial, the influence of irrigation of the subcutaneous tissue using povidone-iodine solution upon the development of postoperative wound infection was examined in 592 patients undergoing general surgical operative procedures. No beneficial effect of irrigation with povidone-iodine solution could be demonstrated, nor could it be demonstrated in the group as a whole or in the subgroups according to bacterial contamination.

Topics: Abdomen; Clinical Trials as Topic; Hernia, Inguinal; Humans; Postoperative Care; Povidone; Povidone-Iodine; Random Allocation; Surgical Wound Infection; Therapeutic Irrigation

Topics: Administration, Topical; Adult; Female; Hernia, Inguinal; Humans; Postoperative Complications; Povidone; Povidone-Iodine; Shock, Septic; Surgical Wound Infection; Tampons, Surgical