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17-04-2013 | Surgery | Article

Triple antiseptic strategy wipes out preoperative bacteria


Free abstract

medwireNews: Meta-analysis results point to a triple-chemical skin cleansing strategy to help reduce the risk for surgical site infection after foot and ankle operations.

Patients whose skin was swabbed with alcoholic chlorhexidine had significantly lower post-preparation culture numbers (post-PCN) at hallux nailfold sites than patients treated with alcoholic povidone-iodine (PI; risk difference=0.19), the researchers say.

For toe web spaces, a two-step process of PI scrub and paint followed by alcohol was significantly better than PI alone (risk difference=0.13).

Furthermore, chlorhexidine scrub followed by alcohol was significantly better than PI scrub and paint alone for combined hallux nail fold and toe web space site outcomes (risk difference=0.27).

As reported in TheBone and Joint Journal, the meta-analysis assessed data from eight studies, including five randomized trials, involving 560 participants and 716 feet in real-life or simulated surgical set-ups.

Data from two studies indicated that bacterial load significantly decreased after preparation. Aerobes were the most common microorganisms detected in the meta-analysis studies, with coagulase-negative staphylococcus (CNS) the most prevalent, followed by diphtheroids and bacillus.

"The high prevalence of CNS after decontamination found in all studies is a serious concern, as it is the major cause of infected orthopaedic implants," explain Kaissar Yammine and Alison Harvey, from Emirates Hospital, Dubai, in the United Arab Emirates.

"Sterilisation of the toes is difficult, and every effort should be made to reduce the microbial load."

Noting that the highest reduction in post-PCN came when three antiseptics were used, the team suggests that this could be a "promising" area for research.

However, acknowledging that their review was conducted in healthy patients without known foot infection or volunteers, they caution: "The generalisability of the results to a different population, such as diabetic patients, would need further investigation."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lynda Williams, Senior medwireNews Reporter

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