Antisepsis Techniques in Orthopedic Surgical Procedures: A Comparative Study

Mendes, Eugênio César; Carvalho, Mauro de Castro; Carvalho, Rafael Baroni; Ferraz, Célio Alves; Souza, Diba Maria S.T.; Schnaider, Taylor B.

doi:10.1055/s-0039-3400520

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Original Articles, Basic • Rev. bras. ortop. 55 (2) • Mar-Apr 2020 • https://doi.org/10.1055/s-0039-3400520 copy

Antisepsis Techniques in Orthopedic Surgical Procedures: A Comparative Study^* * Study performed at Hospital das Clínicas Samuel Libânio, Pouso Alegre, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare antisepsis techniques using chlorhexidine-based soap associated with ethyl alcohol and alcohol-based chlorhexidine or chlorhexidine-based soap associated with alcohol-based chlorhexidine alone in surgical orthopedic procedures.

Methods

This is a primary, randomized, analytical and single-center clinical trial consisting of 170 patients, who were divided into 2 groups. The combinations chlorhexidine-based soap + alcohol-based chlorhexidine (CSAC) and chlorhexidine-based soap + 70% ethyl alcohol + alcohol-based chlorhexidine (CSAAC) were tested in each group. The cultures were grown in mannitol and eosin methylene blue (EMB) after collection before skin preparation (time point 0), after skin preparation (time point 1) and at the end of the surgical procedure (time point 2).

Results

There was no statistically significant difference regarding bacterial growth in mannitol and EMB between the groups at any time point. Moreover, there was no statistical difference between groups and time points regarding the type of bacterial growth in culture media.

Conclusion

There was no difference between these antisepsis techniques for the prevention of surgical site infection in orthopedic procedures; in addition, a protocol containing measures to prevent infection in such procedures was developed.

Keywords
chlorhexidine; infection; orthopedics; operating rooms; antisepsis; surgical procedures

Mannitol		Group
		CSAAC		CSAC		Total
		n	%	n	%	n	%
Time point 0- before skin preparation	Negative growth	6	7.3	16	19.3	22	13.3
	Positive growth	77	92.7	67	80.7	143	86.7
	Total	83	100.0	83	100.0	166	100.0
Time point 1- after skin preparation	Negative growth	52	62.7	43	51.8	94	57.0
	Positive growth	31	37.3	40	48.2	71	43.0
	Total	83	100.0	83	100.0	166	100.0
Time point 2- after incision closure	Negative growth	52	62.7	51	61.4	103	62.0
	Positive growth	31	37.3	32	38.6	63	38.0
	Total	83	100.0	83	100.0	166	100.0

EMB		Group
		CSAAC		CSAC		Total
		n	%	n	%	N	%
Time point 0- before skin preparation	Negative growth	67	80.7	62	74.7	128	77.6
	Positive growth	16	19.3	21	25.3	37	22.4
	Total	83	100.0	83	100.0	165	100.0
Time point 1- after skin preparation	Negative growth	77	92.7	73	88.0	149	90.3
	Positive growth	6	7.3	10	12.0	16	9.7
	Total	83	100.0	83	100.0	165	100.0
Time point 2- after incision closure	Negative growth	75	90.4	74	89.2	149	89.8
	Positive growth	8	9.6	9	10.8	17	10.2
	Total	83	100.0	83	100.0	166	100.0

Bacteria	Group
	CSAAC		CSAC		Total
	n	%	n	%	N	%
Negative growth	49	59.1	43	51.8	92	55.4
GPC	29	35.8	31	37.4	60	36.1
GNB	2	2.4	2	2.4	4	2.4
GPC and GNB	3	3.6	7	8.4	10	6.1
Total	83	100.0	83	100.0	166	100.0

Bacteria	Group
	CSAAC		CSAC		Total
	n	%	n	%	N	%
Negative growth	51	61.4	52	62.6	103	62.0
GPC	26	31.3	27	32.6	53	31.9
GNB	0	.0	0	.0	0	.0
GPC and GNB	6	7.3	4	4.8	10	6.1
Total	83	100.0	83	100.0	166	100.0

Time point	Medium	Group	Mean value (x 10 CFU/mL)
Before skin preparation	EMB	CSAC	17.0843
		CSAAC	12.1707
		Total	14.6424
	Mannitol	CSAC	116.7590
		CSAAC	133.6951
		Total	125.1758
	Total	CSAC	66.9217
		CSAAC	72.9329
		Total	69.9091
After skin preparation	EMB	CSAC	4.9518
		CSAAC	0.2317
		Total	2.6061
	Mannitol	CSAC	21.5542
		CSAAC	4.1707
		Total	12.9152
	Total	CSAC	13.2530
		CSAAC	2.2012
		Total	7.7606
After incision closure	EMB	CSAC	0.3976
		CSAAC	0.2439
		Total	0.3212
	Mannitol	CSAC	3.1807
		CSAAC	15.0122
		Total	9.0606
	Total	CSAC	1.7892
		CSAAC	7.6280
		Total	4.6909
Total	EMB	CSAC	4.4779
		CSAAC	4.2154
		Total	5.8566
	Mannitol	CSAC	47.1647
		CSAAC	50.9593
		Total	49.0505
	Total	CSAC	27.3213
		CSAAC	27.5874
		Total	27.4353

Bacterium	Frequency (%)
Staphylococcus epidermidis	58.33
Staphylococcus aureus	13.88
Acinetobacter iwoffii	11.14
Staphylococcus saprophyticus	4.16
Staphylococcus warneri	4.16
Staphylococcus hominis	2.77
Staphylococcus auricularis	1.39
Staphylococcus capitis-capitis	1.39
Staphylococcus haemolyticus	1.39
Staphylococcus capitis-ureolyticus	1.39

Month	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sept	Oct	Nov	Dec	Total
Number of surgeries	115	101	135	139	131	146	152	129	130	124	123	136	1,561
SSI	7	4	4	3	7	3	2	1	4	1	2	2	40
%	6.1	4.0	2.96	2.16	5.34	2.05	1.32	0.78	3.08	0.81	1.63	1.47	2.64

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Eugênio César Mendes, MD, MSc, Universidade do Vale do Sapucaí, Avenida Tuany Toledo 470, Pouso Alegre, MG, 37550-000, Brasil (e-mail: eugeniocmendes@hotmail.com).

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Antisepsis Techniques in Orthopedic Surgical Procedures: A Comparative Study* * Study performed at Hospital das Clínicas Samuel Libânio, Pouso Alegre, MG, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Antisepsis Techniques in Orthopedic Surgical Procedures: A Comparative Study^* * Study performed at Hospital das Clínicas Samuel Libânio, Pouso Alegre, MG, Brazil.