• Infections
• Foot & Ankle Conditions
• Orthopaedics Clinical Trials

• Infections
• Foot & Ankle Conditions
• Orthopaedics
• Orthopaedics Clinical Trials

Joshua 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.

Surgical 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. J Bone Joint Surg Am 2005].

IA 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.

One 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's 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%; Figure 1), 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>0.05) and after skin closure (16% vs 13%; p>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.

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Figure 1.

Positive Culture Swabs Results

AC=70% isopropyl alcohol rinse followed by chlorhexidine application; CA=chlorhexidine application followed by a 70% isopropyl alcohol rinse.Reproduced with permission from 1 Hunter, MD.

Dr. 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.

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