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Medical device companies and regulatory bodies rely on a nondestructive bacterial sampling technique specified by the American Society for Testing and Materials (ASTM E1173-15) to test preoperative skin preparations (PSPs). Despite the widespread use of PSPs, opportunistic skin-flora pathogens remain the most significant contributor to surgical site infections, suggesting that the ASTM testing standard may be underreporting true dermal bioburden. We hypothesized that ASTM E1173-15 may fail to capture deep skin-dwelling flora. To test this hypothesis, we applied ASTM E1173-15 and a full-thickness skin sampling technique, which we established previously through application to the backs of seven pigs (Yorkshire/Landrace hybrid) following a clinically used PSP (4% chlorhexidine gluconate). The results showed that samples quantified using the full-thickness skin method consistently cultured more bacteria than the ASTM standard, which principally targeted surface-dwelling bacteria. Following PSP, the ASTM standard yielded 1.05 ± 0.24 log10 CFU/cm2, while the full-thickness tissue method resulted in 3.24 ± 0.24 log10 CFU/cm2, more than a 2 log10 difference (p < 0.001). Immunofluorescence images corroborated the data, showing that Staphylococcus epidermidis was present in deep skin regions with or without PSP treatment. Outcomes suggested that a full-thickness sampling technique may better evaluate PSP technologies as it resolves bioburdens dwelling in deeper skin regions. [ABSTRACT FROM AUTHOR]

Medical device companies and regulatory bodies rely on a nondestructive bacterial sampling technique specified by the American Society for Testing and Materials (ASTM E1173-15) to test preoperative skin preparations (PSPs). Despite the widespread use of PSPs, opportunistic skin-flora pathogens remain the most significant contributor to surgical site infections, suggesting that the ASTM testing standard may be underreporting true dermal bioburden. We hypothesized that ASTM E1173-15 may fail to capture deep skin-dwelling flora. To test this hypothesis, we applied ASTM E1173-15 and a full-thickness skin sampling technique, which we established previously through application to the backs of seven pigs (Yorkshire/Landrace hybrid) following a clinically used PSP (4% chlorhexidine gluconate). The results showed that samples quantified using the full-thickness skin method consistently cultured more bacteria than the ASTM standard, which principally targeted surface-dwelling bacteria. Following PSP, the ASTM standard yielded 1.05 ± 0.24 log10 CFU/cm2, while the full-thickness tissue method resulted in 3.24 ± 0.24 log10 CFU/cm2, more than a 2 log10 difference (p < 0.001). Immunofluorescence images corroborated the data, showing that Staphylococcus epidermidis was present in deep skin regions with or without PSP treatment. Outcomes suggested that a full-thickness sampling technique may better evaluate PSP technologies as it resolves bioburdens dwelling in deeper skin regions.

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Objective To investigate the effect of the modified method of preoperative skin cleaning on prevention of surgical site infection(SSI). Methods A total of 1450 patients undergoing spinal surgery were divided into the study group (n=747)and the control group(n=713)According to the preference of surgeons on method of preoperative skin cleaning. The routine preoperative skin preparation was conducted in the control group, and a modified method of preoperative skin cleaning (Jifro hand sanitizer and disinfectant gel)was performed after routine skin preparation in the study group. Besides, 50 patients in the study group were randomly selected for measuring Colony Forming Units (CFU) in the surgical area before and after cleaning the surgical site, and effect of using Jifro hand sanitizer and disinfectant gel CFU in the surgical site was analyzed. Results The incidence of SSI in the control group was 1. 96% and the study group was 0. 67%, which was statistically significant difference (P < 0. 05). After cleaning the surgical site of 50 randomly selected patients, the CFU after cleaning was fewer than that before cleaning(P < 0. 05). Conclusion The preoperative combination of Jifro hand sanitizer and disinfectant gel can effectively reduce the SSI rate and CFU, which is worth promoting in clinical practice. (目的 探讨改良术野皮肤清洁方法预防手术部位感染(SSI)的效果。方法 选取脊柱外科手术患者1450例, 根据手术消毒前皮肤清洁方式不同分为研究组(n=747)和对照组(n=713), 对照组常规清洁手术部位, 观察组在对照组基础上采用 “洁肤柔”洗手液和消毒凝胶清洁手术部位。另外, 随机抽取研究组50例手术患者, 根据清洁前和清洁后的手术区域皮肤进行细菌学菌落数的检测, 分析采用“洁肤柔”洗手液和消毒凝胶对清洁手术部位菌落数的影响。结果 对照组SSI发生率为1. 96%, 研究组SSI发生率为0. 67%, 2组差异有统计学意义(P＜0. 05)。随机抽取研究组50例手术患者手术部位清洁前、后细菌学检测情况, 清洁后菌落数小于清洁前, 差异有统计学意义(P＜0. 05)。结论 术前联合使用“洁肤柔”抗菌洗手液和手消毒凝胶对手术部位进行皮肤清洁, 能有效降低SSI发生率和菌落数。)

Objective: To investigate the role of an adherent soft silicone antimicrobial occlusive foam silver-impregnated dressing for reduction of surgical site infections (SSI) in primary low-transverse caesarean section (1°LTCS) delivery. Method: Women aged 18–45 years admitted to the labour and delivery or the antepartum unit undergoing a 1°LTCS were recruited. Exclusion criteria included repeat caesarean, vertical skin incision, intrapartum fever and closure with staples. Consented participants delivered by scheduled or unscheduled 1°LTCS received the silver-impregnated dressing. Those who declined to participate and were delivered by scheduled or unscheduled caesarean received a standard gauze with tape dressing (controls). Surgical preparation and preoperative antibiotics were administered as per hospital policy. Results: A total of 362 participants were consented for use of the silver-impregnated dressing, with 190 participants undergoing 1°LTCS, of whom 185 were included in the final analysis. Of those who declined to participate, 190 ultimately underwent 1°LTCS during the same time period. Cases and controls were similar in demographics, body mass index, diabetes status, labour and procedure length, and tobacco use. The overall incidence of SSI was 3.7%. A 50% reduction in incidence of SSI was observed in the silver-impregnated dressing group compared with control group (2.7% versus 4.7%, respectively), but this was not statistically significant (p=0.08; odds ratio 0.55; 95% confidence interval: 0.18–1.67). Conclusion: Among women undergoing 1°LTCS with subcuticular closure of a transverse incision, use of a silver-impregnated dressing reduced the rate of SSI by >50% but was not statistically significant. [ABSTRACT FROM AUTHOR]

Clinical preoperative skin preparations (PSPs) do not eradicate skin flora dwelling in the deepest dermal regions. Survivors constitute a persistent infection risk. In search of solutions, we created a porcine model intended for PSP developmental testing. This model employed microbiological techniques sensitive to the deep-dwelling microbial flora as these microorganisms are frequently overlooked when using institutionally-entrenched testing methodologies. Clinical gold-standard PSPs were assessed. Ten Yorkshire pigs were divided into two groups: prepared with either povidone iodine (PVP-I) or chlorhexidine gluconate (CHG) PSP. Bioburdens were calculated on square, 4 cm by 4 cm, full-thickness skin samples homogenized in neutralizing media. Endogenous bioburden of porcine skin (3.3 log10 CFU/cm2) was consistent with natural flora numbers in dry human skin. On-label PSP scrub kits with PVP-I (n = 39) or CHG (n = 40) failed the 2–3 log10-reduction criteria established for PSPs by the Food and Drug Administration (FDA), resulting in a 1.46 log10 and 0.58 log10 reduction, respectively. Porcine dermal microbiota mirrored that of humans, displaying abundant staphylococcal species. Likewise, histological sections showed similarity in hair follicle depths and sebaceous glands (3.2 ± 0.7 mm). These shared characteristics and the considerable fraction of bacteria which survived clinical PSPs make this model useful for developmental work. [ABSTRACT FROM AUTHOR]

Clinical preoperative skin preparations (PSPs) do not eradicate skin flora dwelling in the deepest dermal regions. Survivors constitute a persistent infection risk. In search of solutions, we created a porcine model intended for PSP developmental testing. This model employed microbiological techniques sensitive to the deep-dwelling microbial flora as these microorganisms are frequently overlooked when using institutionally-entrenched testing methodologies. Clinical gold-standard PSPs were assessed. Ten Yorkshire pigs were divided into two groups: prepared with either povidone iodine (PVP-I) or chlorhexidine gluconate (CHG) PSP. Bioburdens were calculated on square, 4 cm by 4 cm, full-thickness skin samples homogenized in neutralizing media. Endogenous bioburden of porcine skin (3.3 log10 CFU/cm2) was consistent with natural flora numbers in dry human skin. On-label PSP scrub kits with PVP-I (n = 39) or CHG (n = 40) failed the 2–3 log10-reduction criteria established for PSPs by the Food and Drug Administration (FDA), resulting in a 1.46 log10 and 0.58 log10 reduction, respectively. Porcine dermal microbiota mirrored that of humans, displaying abundant staphylococcal species. Likewise, histological sections showed similarity in hair follicle depths and sebaceous glands (3.2 ± 0.7 mm). These shared characteristics and the considerable fraction of bacteria which survived clinical PSPs make this model useful for developmental work.

To study the relationship between different preoperative skin preparation schemes and surgical site infection (SSI)so as to provide the reference for reducing the clinical incidence rate of SSI. A total of 1810 patients who were received surgery in hospital from January 2015 to December 2019 were selected as the study subjects. According to the factorial design table, the three factors of factor A: whether shaving(1 without shaving; 2 shaving), factor B:cleaning methods(1 water cleaning; 2 soap water cleaning), factor C: preoperative skin preparation time(1 1d before surgery; 2 2h before surgery) were divided into 8 pairing groups, they were A1B1C1 group with 226 patients, A1B2C1 group with 229 patients, A1B1C2 group with 216 patients, A1B2C2 group with 232 patients, A2B1C1 group with 221 patients, A2B2C1 group with 241 patients, A2B1C2 group with 221 patients, A2B2C2 group with 224 patients, the distribution of surgical sites and incision types and the incidence rate of SSI in different groups were compared, and the correlation and interaction of colony counting among different groups analyzed by factorial analysis after preoperative skin preparation. The differences of the surgical sites and incision types in different groups had no statistical significant (P>0.05). The incidence rates of SSI were higher in A1B1C1 group and A2B1C1 group, the incidence rates were 12.83% and 14.48% respectively. The incidence rates of SSI at level A1 was 8.75%, which had no statistical difference than 8.27% at level A2 (P>0.05). The incidence rates of SSI at B1, C1 levels were 11.31%, 10.03% respectively, which were significantly higher than 5.83%, 6.94% at B2, C2 levels, the differences were statistically significant (P<0.05). The difference of colony counting among different groups after preoperative skin preparation had statistical significant(P<0.05), and the factorial analysis showed the difference of single factors of B, C had statistical significant(P<0.05), and there were interaction between A and C, B and C, furthermore, there was second-level interaction among A, B, C(P<0.05). Preoperative skin preparation plays an important role in reducing the incidence rate of SSI, in actual practice, it is suggest to using soap water or other disinfection to clean the skin and complete skin preparation in a relatively short period of time. [ABSTRACT FROM AUTHOR]

Background Benzoyl peroxide (BPO) solutions effectively reduce Cutibacterium acnes (formerly Propionibacterium acnes ) on the face, neck, and back in nonoperative settings. This study compared preoperative application of BPO vs. chlorhexidine gluconate (CHG) in decreasing shoulder C acnes skin burden in surgical patients. Methods Eighty patients undergoing shoulder surgery were prospectively enrolled in a randomized double-blind trial at 1 institution from August 2015 to April 2017. Participants were randomized to 5% BPO or 4% CHG for 3 consecutive days. The nonoperative shoulder had no intervention and served as the negative control. Skin cultures of both shoulders were obtained via a detergent scrub technique the day of surgery at anterior, lateral, and posterior sites and the axilla. Results Fewer positive cultures were obtained from the BPO-treated side compared with the contralateral side ( P  = .0003), and no change was shown for the CHG group ( P  = .80). Shoulders treated with BPO showed a statistically significant reduction in C acnes counts compared with CHG at anterior ( P  = .03) and posterior ( P  = .005) portal sites. No significant difference was found at the axilla ( P  = .99) or lateral portal site ( P  = .08). No postoperative infections or wound complications occurred in either group. Conclusions BPO is more effective than CHG at reducing C acnes on the shoulder. Decreasing the skin burden of C acnes may reduce intraoperative wound contamination and postoperative infection. BPO should be considered as an adjunctive preoperative skin preparation considering its potential benefit, low risk, and low cost. [ABSTRACT FROM AUTHOR]

Postoperative surgical site infections (SSIs) are serious health care-associated infections that contribute to higher rates of mortality. Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of SSIs. A quality improvement intervention was developed to identify surgical patients with nasal colonization of MRSA, treat them with mupirocin, and introduce a new preoperative skin antisepsis protocol using 2% chlorhexidine gluconate cloths. The total number of SSIs was reduced by 63%, and MRSA SSIs decreased by 78%. Preoperative MRSA screening and treatment and the preoperative skin antisepsis protocol were smoothly integrated into the facility workflow and well accepted by patients. This intervention saved two community hospitals an estimated $240,000. AORN J 92 (September 2010) 288-296. © AORN, Inc, 2010. [ABSTRACT FROM AUTHOR]

Background: Orthopedic surgical procedures involving the foot and ankle are associated with high rates of infection. The optimal method of preparing the skin and nails for foot and ankle surgery remains unknown. Objective: This study was conducted to compare the efficacy of 4 different methods of skin and nail preparation of the foot using various antiseptic solutions. Methods: In this prospective, randomized study, 4 methods of skin and nail preparation were compared in terms of their efficacy in eliminating bacteria from the hallux nailfold and first web space of the normal foot in 28 healthy adult volunteers. Efficacy was determined by evaluating the difference in the total bacterial load before and after skin preparation. The foot-preparation solutions evaluated were 4% chlorhexidine gluconate, 70% isopropyl alcohol, and 7.5% to 10% povidone-iodine. Results: The addition of alcohol to povidone-iodine was found to increase the efficacy of the preparation method. The nailfold remained contaminated after any of the preoperative skin- and nail-preparation methods studied. Limitations: This study did not measure clinically relevant infections, and the results may not correlate with decreased rates of infection after surgery. Conclusion: Incorporation of alcohol and povidone-iodine into the preoperative skin- and nail-preparation process may help reduce the bacterial load. Every effort should be made to lower the risk of contamination from the nail. [Copyright &y& Elsevier]