ROLE OF ANTISEPTIC SOLUTION (PYODINE) TO PREVENT INFECTION DURING MESH PLACEMENT

R WASEEM; M GHAYASUDDIN; S SALMAN; B JAWAID; U ERUM; B SHAKEEL

doi:10.54112/bcsrj.v2024i1.868

Authors

R WASEEM Department of General Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan
M GHAYASUDDIN Department of General Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan
S SALMAN Department of General Surgery, Civil Hospital Karachi, Pakistan
B JAWAID Department of General Surgery, Dr Ruth K. M. Pfau Civil Hospital Karachi, Pakistan
U ERUM Department of General Surgery, Watim Medical and Dental College Islamabad, Pakistan
B SHAKEEL Department of General Surgery, Sindh Government Hospital Murad Memon, Karachi

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.868

Keywords:

Chlorhexidine, Mesh Replacement, Povidone-Iodine, Surgical Site Infection, Wound Infection

Abstract

Surgical site infections (SSIs) are a significant complication in postoperative care, leading to increased morbidity and healthcare costs. Antiseptic solutions for preoperative skin preparation are crucial in minimising SSIs. Chlorhexidine-alcohol and povidone-iodine solutions are commonly used, but their comparative efficacy in preventing SSIs, especially in mesh replacement surgeries, needs further investigation. Objective: This study aimed to determine the occurrence of surgical site infection (SSI) in wounds after applying povidone-iodine and chlorhexidine-alcohol solutions during mesh replacement surgeries. Methods: This randomised controlled trial was conducted at Kulsoom Bai Valika Hospital, Karachi, from August 1, 2023, to January 31, 2024. Following ethical approval from the institutional review board, 240 patients aged 20-65 undergoing elective surgery were included through non-probability consecutive sampling. Patients allergic to the study solutions or who refused to participate were excluded. Participants were randomly assigned to Group A (chlorhexidine-alcohol, n=120) and Group B (povidone-iodine, n=120). Post-surgery, Group A wounds were scrubbed with chlorhexidine-alcohol and Group B with povidone-iodine. Patients were monitored daily until discharge. Statistical analysis was performed using chi-square tests to compare the incidence of SSIs between the groups. Results: The mean age of participants was 41.32±11.6 years in Group A and 41.62±11.5 years in Group B. Within a 30-day follow-up, SSIs were observed in 23% of Group A and 40% of Group B (p<0.0001). Superficial incisional infections were 16% in Group A and 28% in Group B (p<0.0001). Deep incisional infections were 6% in Group A and 13% in Group B (p=0.004). Conclusion: The use of chlorhexidine-alcohol for antisepsis in mesh replacement surgeries significantly reduced the incidence of surgical site infections compared to povidone-iodine-alcohol. This suggests that chlorhexidine-alcohol is a more effective antiseptic solution for preventing SSIs in such procedures.

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References

Gillespie BM, Harbeck E, Rattray M, Liang R, Walker R, Latimer S, et al. Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients. International Journal of Surgery. 2021;95:106136.

López-Cano M, Kraft M, Curell A, Puig-Asensio M, Balibrea J, Armengol-Carrasco M, et al. Use of topical antibiotics before primary incision closure to prevent surgical site infection: a meta-analysis. Surgical Infections. 2019;20(4):261-70.

Chen S, Chen JW, Guo B, Xu CC. Preoperative antisepsis with chlorhexidine versus povidone-iodine for the prevention of surgical site infection: a systematic review and meta-analysis. World Journal of Surgery. 2020;44:1412-24.

Thomas LV. Evaluation of polymeric biomaterials used as wound care products. Biomedical Product and Materials Evaluation: Elsevier; 2022. p. 63-94.

Bandyopadhyay D. Topical antibacterials in dermatology. Indian journal of dermatology. 2021;66(2):117-25.

Lee 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. Infection Control & Hospital Epidemiology. 2010;31(12):1219-29.

Noorani A, Rabey N, Walsh S, Davies R. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone–iodine in clean-contaminated surgery. Journal of British Surgery. 2010;97(11):1614-20.

Bibbo C, Patel DV, Gehrmann RM, Lin SS. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clinical Orthopaedics and Related Research (1976-2007). 2005;438:204-8.

Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. JBJS. 2009;91(8):1949-53.

Darouiche RO, Wall Jr MJ, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. New England Journal of Medicine. 2010;362(1):18-26.

Tuuli MG, Liu J, Stout MJ, Martin S, Cahill AG, Colditz G, et al. 4: Chlorhexidine-alcohol compared with iodine-alcohol for preventing surgical-site infection at cesarean: a randomized controlled trial. American Journal of Obstetrics & Gynecology. 2016;214(1):S3-S4.

Maiwald M. Chlorhexidine-alcohol compared with povidone-iodine for surgical-site antisepsis in cesarean deliveries. Obstetrics & Gynecology. 2013;121(2 PART 1):378-9.