Comparison of the antimicrobial efficacy of povidone-iodine-alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic skin flora of the shoulder region

Antimicrobial Resistance & Infection Control

Georg Daeschlein¹  Julian Camill Harnoss²  Matthias Maiwald³  Thomas Kohlmann⁴  Günter Kampf⁵  Dorothea Dörfel⁵  Gerald Müller⁵  Axel Kramer⁵  Ojan Assadian⁶  Robert Hudek⁷ 

[1] Department of Dermatology, University Medicine Greifswald, Greifswald, Germany;Working Group Clinical Antisepsis, German Society of Hospital Hygiene, Berlin, Germany;Department of General, Visceral and Transplantation Surgery and Study Center, German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany;Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore;Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Duke-National University of Singapore Postgraduate School of Medicine, Singapore, Singapore;Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany;Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany;Regional Hospital Wiener Neustadt, Vienna, Austria;Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK;Shoulder and Elbow Surgery, Rhön-Klinikum AG, Bad Neustadt/Saale, Germany;

关键词: Skin antisepsis;    Shoulder surgery;    Chlorhexidine;    Povidone-iodine;    Alcohol;   

DOI  :  10.1186/s13756-020-00874-8

来源: Springer

【 摘 要 】

BackgroundCutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery. We hypothesized that prolonged skin preparation with an agent that penetrates deeply into the skin would be beneficial. Thus, we compared two classes of antiseptics, each combined with alcohol, each applied with two different contact times.MethodsUsing a cross-over arrangement, shoulders of 16 healthy volunteers were treated for 2.5 min (standard) or 30 min (prolonged) with alcohol-based chlorhexidine (CHG-ALC) or alcohol-based povidone-iodine (PVP-I-ALC). Skin sites were sampled before, immediately after, and 3 h after treatment, using a standardized cup-scrub technique.ResultsAerobic skin flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after 2.5 min application and immediate sampling (reduction factor [RF] 2.55 ± 0.75 vs. 1.94 ± 0.91, p = 0.04), but not after prolonged contact times and 3-h sampling. Coagulase-negative staphylococci were completely eliminated after PVP-I-ALC application, but still recovered from 4 of 32 samples after CHG-ALC application. Anaerobic flora was reduced more effectively by PVP-I-ALC than CHG-ALC after standard (RF 3.96 ± 1.46 vs. 1.74 ± 1.24, p < 0.01) and prolonged (RF 3.14 ± 1.20 vs. 1.38 ± 1.16, p < 0.01) contact times and immediate sampling, but not after 3-h sampling. No adverse events were reported.ConclusionsPVP-I-ALC showed marginal benefits concerning the aerobic flora, but more substantial benefits over CHG-ALC concerning the anaerobic flora of the shoulder. Standard and prolonged contact times showed superiority for PVP-I-ALC for anaerobic flora at all immediate sampling points, but missed significance at 3-h sampling. The results underscore the need for protection against C. acnes and coagulase-negative staphylococci in orthopaedic surgery. The clinical relevance of these findings, however, should be studied with SSI as an endpoint.

【 授权许可】

CC BY