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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents results from a prospectively randomized, single-blind study, demonstrating that the order in which isopropyl alcohol and chlorhexidine gluconate skin preparation solutions are applied does not affect wound infection rates in patients undergoing foot and ankle orthopedic surgery.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInfections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFoot \u0026amp; Ankle Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInfections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFoot \u0026amp; Ankle Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EJoshua Hunter, MD, University of Rochester Medical Center, Rochester, New York, USA, presented results from a prospectively randomized, single-blind study, demonstrating that the order in which isopropyl alcohol (IA) and chlorhexidine gluconate (CG) skin preparation solutions are applied does not affect wound infection rates in patients undergoing foot and ankle orthopedic surgery.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESurgical site infections are among the most common postoperative complications encountered by foot and ankle surgeons, and can make for difficult clinical scenarios. Although the skin surface represents one source of pathogens that may contribute to these infections, numerous skin preparation agents are used prior to surgery to reduce the risk of postoperative complications [Ostrander RV et al. \u003Cem\u003EJ Bone Joint Surg Am\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIA and CG are two commonly used skin preparation agents which have potential synergistic qualities to prevent postsurgical infection. With this in mind, Dr. Hunter and colleagues conducted a prospectively randomized, single-blind study to determine whether the order of applying these two solutions has a significant effect on the residual load of bacterial pathogens after surgical site preparation for foot and ankle surgery.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOne hundred patients undergoing surgery of the foot and ankle with a single surgeon were prospectively randomized to two surgical preparation groups. In Group 1 (CA; n=49), patients underwent surgical site preparation consisting of a 4% CG application followed by a 70% IA rinse; this process was repeated and allowed to dry. For patients in Group 2 (AC; n=45), surgical site preparation consisted of IA followed by CG, which was then repeated. Swabs for aerobic bacterial culture were collected from the third web space of each patient\u0027s operative foot before surgical site preparation, post skin preparation, before wound site closure, and after wound closure. Patients were followed for 6 months postoperatively to monitor for wound complications. Six patients were excluded from the study due to incomplete bacterial culture data. In both groups, all swabs obtained before surgical site preparation were culture-positive for bacteria. More of the post-skin preparation swabs in the CA group were bacterial culture-positive compared with those in the AC group (18.7% vs 10.9%; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E), but this was not statistically significant (p=0.07). However, there was a significant increase in culture-positive post-draping swabs in the CA group compared with those in the AC group (22% vs 4%; p=0.015). There was no significant difference between the groups in culture-positive swabs taken before skin closure (18% vs 15%; p\u0026gt;0.05) and after skin closure (16% vs 13%; p\u0026gt;0.05). One superficial surgical site infection occurred in each group during the first 6 months postoperatively, and both were successfully treated with oral antibiotics.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/2\/16.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Positive Culture Swabs Results\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1261815914\u0022 data-figure-caption=\u0022Positive Culture Swabs Results\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/2\/16.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/2\/16.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/2\/16.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15652\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EPositive Culture Swabs Results\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAC=70% isopropyl alcohol rinse followed by chlorhexidine application; CA=chlorhexidine application followed by a 70% isopropyl alcohol rinse.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from 1 Hunter, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EDr. Hunter stated that postoperative infection rates following foot and ankle surgery are low, and emphasized that both CG and IA are effective at reducing surgical site bacterial colonization when combined. Although the results from this study showed that applying IA before CG solution more effectively reduces the number of positive bacterial cultures in samples taken after draping, he concluded that the order of application of these agents had no influence on the incidence of postsurgical wound infection.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/2\/16.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzpcu1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzpcu1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}