Measures for the Prevention of Surgical Site Infection
Orthopedics
Antisepsis Techniques in Orthopedic Surgical Procedures: a Comparative Study
1 other identifier
interventional
170
1 country
1
Brief Summary
Among the causes associated with infection of hospitalized patients, surgical site infection is a complication that is potentially associated with any type of surgical procedure, it also represents an expressive burden in terms of morbidity and mortality, as well as additional costs for health care systems around the world. It is regarded that the efficiency of the pre, per, and postoperative skin preparation depends on both the adopted antiseptic and the application method, with Chlorhexidine currently being the most used drug in such preparation. However, the manner, timing, or timing of cutaneous antisepsis action is unclear. Objective: Comparing antisepsis techniques using chlorhexidine-based soap associated with ethyl alcohol and alcoholic chlorhexidine versus chlorhexidine-based soap associated with alcoholic chlorhexidine, in surgical orthopedic procedures.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Jun 2017
Shorter than P25 for not_applicable
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
Study Start
First participant enrolled
June 30, 2017
CompletedPrimary Completion
Last participant's last visit for primary outcome
November 7, 2017
CompletedStudy Completion
Last participant's last visit for all outcomes
November 7, 2017
CompletedFirst Submitted
Initial submission to the registry
April 8, 2018
CompletedFirst Posted
Study publicly available on registry
June 11, 2018
CompletedJune 11, 2018
May 1, 2018
4 months
April 8, 2018
June 8, 2018
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Incidence of bacterial skin colonization
Skin culture
about 6 hours
Study Arms (2)
CSAAC group
ACTIVE COMPARATORThe CSAAC group (chlorhexidine-based soap + ethyl alcohol + alcoholic chlorhexidine): skin preparation process with 4% chlorhexidine-based soap for a period of 5 minutes, followed by a sterile and soaked with 70% alcohol compress. After removing the chlorhexidine-based soap excess, antisepsis was performed with alcoholic chlorhexidine and surgical drapes and gowns. Cultures were performed in the mannitol and EMB (Eosin Methylene Blue) media after being collected at the pre-skin preparation, post-skin preparation process and end of the surgical procedure.
CSAC group
ACTIVE COMPARATORThe CSAC group (chlorhexidine-based soap + alcoholic chlorhexidine): skin preparation process with 4% chlorhexidine-based soap for a period of 5 minutes and the of a simple, dry and sterile compress to remove the excess. After removing the excess, antisepsis was performed with alcoholic chlorhexidine and surgical drapes and gowns. Cultures were performed in the mannitol and EMB media after being collected at the pre-skin preparation, post-skin preparation process and end of the surgical procedure.
Interventions
Skin preparation with 4% chlorhexidine-based soap for a period of 5 minutes, followed by a sterile and soaked with 70% alcohol compress. After removing the chlorhexidine-based soap excess, antisepsis was performed with alcoholic chlorhexidine and surgical drapes and gowns.
Skin preparation with 4% chlorhexidine-based soap for a period of 5 minutes and the of a simple, dry and sterile compress to remove the excess. After removing the excess, antisepsis was performed with alcoholic chlorhexidine and surgical drapes and gowns.
Eligibility Criteria
You may qualify if:
- patients both males and females; older than 18 years old who will undergo orthopaedic surgical procedures;
You may not qualify if:
- patients who do not follow the medical guidelines; that are non-collaborative and / or do not sign the terms of consent.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
Universidade do Vale do Sapucai
Pouso Alegre, Minas Gerais, 37.550-000, Brazil
Related Publications (30)
Bohl DD, Ondeck NT, Darrith B, Hannon CP, Fillingham YA, Della Valle CJ. Impact of Operative Time on Adverse Events Following Primary Total Joint Arthroplasty. J Arthroplasty. 2018 Jul;33(7):2256-2262.e4. doi: 10.1016/j.arth.2018.02.037. Epub 2018 Feb 17.
PMID: 29551302BACKGROUNDCapen DA, Calderone RR, Green A. Perioperative risk factors for wound infections after lower back fusions. Orthop Clin North Am. 1996 Jan;27(1):83-6.
PMID: 8539055BACKGROUNDCharles D, Heal CF, Delpachitra M, Wohlfahrt M, Kimber D, Sullivan J, Browning S, Saednia S, Hardy A, Banks J, Buttner P. Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial. CMAJ. 2017 Aug 8;189(31):E1008-E1016. doi: 10.1503/cmaj.161460.
PMID: 28790056BACKGROUNDCheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt). 2017 Aug/Sep;18(6):722-735. doi: 10.1089/sur.2017.089.
PMID: 28832271BACKGROUNDDicks KV, Baker AW, Durkin MJ, Anderson DJ, Moehring RW, Chen LF, Sexton DJ, Weber DJ, Lewis SS. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures. Infect Control Hosp Epidemiol. 2015 Dec;36(12):1431-6. doi: 10.1017/ice.2015.222. Epub 2015 Sep 22.
PMID: 26391277BACKGROUNDDrakos MC, Murphy CI. Bracing versus casting in ankle fractures. Phys Sportsmed. 2014 Nov;42(4):60-70. doi: 10.3810/psm.2014.11.2092.
PMID: 25419889BACKGROUNDDuchman KR, Pugely AJ, Martin CT, Gao Y, Bedard NA, Callaghan JJ. Operative Time Affects Short-Term Complications in Total Joint Arthroplasty. J Arthroplasty. 2017 Apr;32(4):1285-1291. doi: 10.1016/j.arth.2016.12.003. Epub 2016 Dec 14.
PMID: 28040399BACKGROUNDEllenhorn JD, Smith DD, Schwarz RE, Kawachi MH, Wilson TG, McGonigle KF, Wagman LD, Paz IB. Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites. J Am Coll Surg. 2005 Nov;201(5):737-41. doi: 10.1016/j.jamcollsurg.2005.05.023. Epub 2005 Aug 31.
PMID: 16256917BACKGROUNDGeorge J, Klika AK, Higuera CA. Use of Chlorhexidine Preparations in Total Joint Arthroplasty. J Bone Jt Infect. 2017 Jan 1;2(1):15-22. doi: 10.7150/jbji.16934. eCollection 2017.
PMID: 28529860BACKGROUNDGlassman SD, Dimar JR, Puno RM, Johnson JR. Salvage of instrumental lumbar fusions complicated by surgical wound infection. Spine (Phila Pa 1976). 1996 Sep 15;21(18):2163-9. doi: 10.1097/00007632-199609150-00021.
PMID: 8893444BACKGROUNDHosseini P, Mundis GM Jr, Eastlack R, Nourian A, Pawelek J, Nguyen S, Akbarnia BA. Do Longer Surgical Procedures Result in Greater Contamination of Surgeons' Hands? Clin Orthop Relat Res. 2016 Jul;474(7):1707-13. doi: 10.1007/s11999-016-4832-1. Epub 2016 Apr 18.
PMID: 27090260BACKGROUNDHouang ET, Buckley R, Smith M, O'Riordan SM. Survival of Pseudomonas aeruginosa in plaster of Paris. J Hosp Infect. 1981 Sep;2(3):231-5. doi: 10.1016/0195-6701(81)90042-6. No abstract available.
PMID: 6174590BACKGROUNDKamel C, McGahan L, Mierzwinski-Urban M, Embil J. Preoperative Skin Antiseptic Preparations and Application Techniques for Preventing Surgical Site Infections: A Systematic Review of the Clinical Evidence and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2011 Jun. Available from http://www.ncbi.nlm.nih.gov/books/NBK174549/
PMID: 24354038BACKGROUNDLee 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 Dec;31(12):1219-29. doi: 10.1086/657134. Epub 2010 Oct 22.
PMID: 20969449BACKGROUNDLevi AD, Dickman CA, Sonntag VK. Management of postoperative infections after spinal instrumentation. J Neurosurg. 1997 Jun;86(6):975-80. doi: 10.3171/jns.1997.86.6.0975.
PMID: 9171176BACKGROUNDMartinez J, Macias JH, Arreguin V, Alvarez JA, Macias AE, Mosqueda-Gomez JL. Isopropyl alcohol is as efficient as chlorhexidine to prevent contamination of blood cultures. Am J Infect Control. 2017 Apr 1;45(4):350-353. doi: 10.1016/j.ajic.2016.11.027. Epub 2017 Jan 12.
PMID: 28089672BACKGROUNDMears SC, Dinah AF, Knight TA, Frassica FJ, Belkoff SM. Visibility of surgical site marking after preoperative skin preparation. Eplasty. 2008 Jul 16;8:e35.
PMID: 18709136BACKGROUNDOvaska MT, Makinen TJ, Madanat R, Huotari K, Vahlberg T, Hirvensalo E, Lindahl J. Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am. 2013 Feb 20;95(4):348-53. doi: 10.2106/JBJS.K.01672.
PMID: 23426769BACKGROUNDPeel TN, Cheng AC, Buising KL, Dowsey MM, Choong PF. Alcoholic Chlorhexidine or Alcoholic Iodine Skin Antisepsis (ACAISA): protocol for cluster randomised controlled trial of surgical skin preparation for the prevention of superficial wound complications in prosthetic hip and knee replacement surgery. BMJ Open. 2014 May 15;4(5):e005424. doi: 10.1136/bmjopen-2014-005424.
PMID: 24833699BACKGROUNDProttey C, Pryce NG. Hand cleansing and skin condition. A comparison of conventional soap washing and the use of alcohol-impregnated paper cloths. Int J Cosmet Sci. 1987 Apr;9(2):53-8. doi: 10.1111/j.1467-2494.1987.tb00462.x.
PMID: 19456969BACKGROUNDReichel M, Heisig P, Kohlmann T, Kampf G. Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob Agents Chemother. 2009 Nov;53(11):4778-82. doi: 10.1128/AAC.00582-09. Epub 2009 Sep 8.
PMID: 19738017BACKGROUNDRidgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br. 2005 Jun;87(6):844-50. doi: 10.1302/0301-620X.87B6.15121.
PMID: 15911671BACKGROUNDRoy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res. 1986 Feb;(203):7-17.
PMID: 3955999BACKGROUNDSaltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am. 2009 Aug;91(8):1949-53. doi: 10.2106/JBJS.H.00768.
PMID: 19651954BACKGROUNDSavage JW, Anderson PA. An update on modifiable factors to reduce the risk of surgical site infections. Spine J. 2013 Sep;13(9):1017-29. doi: 10.1016/j.spinee.2013.03.051. Epub 2013 May 24.
PMID: 23711958BACKGROUNDSchepers T, De Vries MR, Van Lieshout EM, Van der Elst M. The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature. Int Orthop. 2013 Mar;37(3):489-94. doi: 10.1007/s00264-012-1753-9. Epub 2013 Jan 4.
PMID: 23288046BACKGROUNDSegal CG, Anderson JJ. Preoperative skin preparation of cardiac patients. AORN J. 2002 Nov;76(5):821-8. doi: 10.1016/s0001-2092(06)61035-1.
PMID: 12463081BACKGROUNDVeiga DF, Damasceno CAV, Veiga-Filho J, Figueiras RG, Vieira RB, Florenzano FH, Juliano Y, Ferreira LM. Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. Plast Reconstr Surg. 2008 Nov;122(5):170e-171e. doi: 10.1097/PRS.0b013e318186cd7f. No abstract available.
PMID: 18971711BACKGROUNDVioreanu M, Dudeney S, Hurson B, Kelly E, O'Rourke K, Quinlan W. Early mobilization in a removable cast compared with immobilization in a cast after operative treatment of ankle fractures: a prospective randomized study. Foot Ankle Int. 2007 Jan;28(1):13-9. doi: 10.3113/FAI.2007.0003.
PMID: 17257532BACKGROUNDWeed S, Bastek JA, Sammel MD, Beshara M, Hoffman S, Srinivas SK. Comparing postcesarean infectious complication rates using two different skin preparations. Obstet Gynecol. 2011 May;117(5):1123-1129. doi: 10.1097/AOG.0b013e3182118e98.
PMID: 21508751BACKGROUND
MeSH Terms
Conditions
Study Officials
- PRINCIPAL INVESTIGATOR
Eugenio C Mendes, MD
Universidade do Vale do Sapucai
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- PREVENTION
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
April 8, 2018
First Posted
June 11, 2018
Study Start
June 30, 2017
Primary Completion
November 7, 2017
Study Completion
November 7, 2017
Last Updated
June 11, 2018
Record last verified: 2018-05
Data Sharing
- IPD Sharing
- Will not share