Effect of Incise Drape on Contamination Rate of Surgical Wound during Surgical Procedures of Lumbar Spine

Zarei, Mohammadreza; Tabesh, Homayoun; Fazeli, Hossein; Aarabi, Akram

Effect of Incise Drape on Contamination Rate of Surgical Wound during Surgical Procedures of Lumbar Spine

Authors

¹ Department of Operating Room, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

³ Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

⁴ Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The aim of this study was to investigate the effect of the incise drape (ID) on surgical wound bacterial contamination during lumbar spine surgical procedures in treatment group (with ID) and control group (without ID). Materials and Methods: The present study was conducted on 88 patients who were a candidate for lumbar spine surgery. The patients were randomly assigned to one of the two groups, treatment and control. The ID was only used in the treatment group. The surgical wound sampling for bacterial culture was done in two steps, immediately after surgical incision (IASI) and immediately prior to the surgical wound closure (IPSWC). The samples were then sent to the laboratory. Results: The mean total bacterial count of the surgical wound in the stage IASI was not significantly different between treatment and control groups (0.09 vs. 0.02, P = 0.31). However, this means in the stage IPSWC in treatment group was significantly more than the control group (18.6 vs. 0.41, P = 0.04). The frequency distribution of Staphylococcus aureus (25% vs. 3%, P = 0.02) and Staphylococcus epidermidis (36.4% vs. 9.1%, P = 0.002) was significantly higher in the treatment group compared with control group in the stage IPSWC. Conclusion: The results suggest that the use of ID is unable to reduce surgical wound bacterial contamination in clean lumbar spine surgery. Therefore, based on the results obtained in our study, the application of ID is not recommended as an essential action for the prevention of surgical wound contamination.

Keywords

References

1.	Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O. Postoperative infections of the lumbar spine: Presentation and management. Int Orthop 2012;36:439-44.
2.	Garner BH, Anderson DJ. Surgical site infections: An update. Infect Dis Clin North Am 2016;30:909-29.
3.	Zinn J, Jenkins JB, Swofford V, Harrelson B, McCarter S. Intraoperative patient skin prep agents: Is there a difference? AORN J 2010;92:662-74.
4.	Casey AL, Karpanen TJ, Nightingale P, Conway BR, Elliott TS. Antimicrobial activity and skin permeation of iodine present in an iodine-impregnated surgical incise drape. J Antimicrob Chemother 2015;70:2255-60.
5.	Grove GL, Eyberg CI. Comparison of two preoperative skin antiseptic preparations and resultant surgical incise drape adhesion to skin in healthy volunteers. J Bone Joint Surg Am 2012;94:1187-92.
6.	Talbot TR. Surgical site infections and antimicrobial prophylaxis. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8^th ed. Canada: Elsevier; 2015.
7.	Lilly HA, Lowbury EJ, London PS, Porter MF. Effects of adhesive drapes on contamination of operation wounds. Lancet 1970;2:431-2.
8.	Falk-Brynhildsen K, Söderquist B, Friberg O, Nilsson UG. Bacterial recolonization of the skin and wound contamination during cardiac surgery: A randomized controlled trial of the use of plastic adhesive drape compared with bare skin. J Hosp Infect 2013;84:151-8.
9.	Ward HR, Jennings OG, Potgieter P, Lombard CJ. Do plastic adhesive drapes prevent post caesarean wound infection? J Hosp Infect 2001;47:230-4.
10.	Anderson BE, editor. The Netter Collection of Medical Illustrations-Integumentary System E-Book. China: Elsevier Health Sciences; 2012.
11.	Alijanipour P, Karam J, Llinás A, Vince KG, Zalavras C, Austin M, et al. Operative environment. J Orthop Res 2014;32 Suppl 1:S60-80.
12.	Ho VP, Eachempati SR, Barie PS. Surgical Site Infections In: Moore LJ, Turner KL, Todd SR, editors. Common Problems in Acute Care Surgery. 1^st ed. New York: Springer; 2013.
13.	French ML, Eitzen HE, Ritter MA. The plastic surgical adhesive drape: An evaluation of its efficacy as a microbial barrier. Ann Surg 1976;184:46-50.
14.	World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization Document Production Services; 2016.
15.	Yoshimura Y, Kubo S, Hirohashi K, Ogawa M, Morimoto K, Shirata K, et al. Plastic iodophor drape during liver surgery operative use of the iodophor-impregnated adhesive drape to prevent wound infection during high risk surgery. World J Surg 2003;27:685-8.
16.	Rezapoor M, Tan TL, Maltenfort MG, Parvizi J. Incise draping reduces the rate of contamination of the surgical site during hip surgery: A prospective, randomized trial. J Arthroplasty 2018;33:1891-5.
17.	Leaper D, Burman-Roy S, Palanca A, Cullen K, Worster D, Gautam-Aitken E, et al. Prevention and treatment of surgical site infection: Summary of NICE guidance. BMJ 2008;337:a1924.
18.	Webster J, Alghamdi A. Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev 2015; 4:CD006353.
19.	Falk-Brynhildsen K, Friberg O, Söderquist B, Nilsson UG. Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes. Biol Res Nurs 2013;15:242-8.
20.	Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S66-88.
21.	Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect Dis 2016;16:e276-87.
22.	Darmstadt GL, Hossain MM, Choi Y, Shirin M, Mullany LC, Islam M, et al. Safety and effect of chlorhexidine skin cleansing on skin flora of neonates in Bangladesh. Pediatr Infect Dis J 2007;26:492-5.
23.	Owen LJ, Gines JA, Knowles TG, Holt PE. Efficacy of adhesive incise drapes in preventing bacterial contamination of clean canine surgical wounds. Vet Surg 2009;38:732-7.
24.	Berríos-Torres SI, Yi SH, Bratzler DW, Ma A, Mu Y, Zhu L, et al. Activity of commonly used antimicrobial prophylaxis regimens against pathogens causing coronary artery bypass graft and arthroplasty surgical site infections in the United States, 2006-2009. Infect Control Hosp Epidemiol 2014;35:231-9.
25.	Fairclough JA, Johnson D, Mackie I. The prevention of wound contamination by skin organisms by the pre-operative application of an iodophor impregnated plastic adhesive drape. J Int Med Res 1986;14:105-9.
26.	Falk-Brynhildsen K, Söderquist B, Friberg O, Nilsson UG. Response to M.H. Stevens and N.M. Klinger, re: Bacterial recolonization of the skin and wound contamination during cardiac surgery. J Hosp Infect 2013;85:325.
27.	Makki D, Probert N, Gedela V, Kustos I, Thonse R, Banim R, et al. Lifting incise drapes off the skin during wound closure can cause contamination. J Perioper Pract 2015;25:112-4.
28.	Alexander JW, Aerni S, Plettner JP. Development of a safe and effective one-minute preoperative skin preparation. Arch Surg 1985;120:1357-61.
29.	Artz CP, Conn JH, Howard HS. Protection of the surgical wound with a new plastic film. JAMA 1960;174:1865-8.
30.	Bejko J, Tarzia V, Carrozzini M, Gallo M, Bortolussi G, Comisso M, et al. Comparison of efficacy and cost of iodine impregnated drape vs. Standard drape in cardiac surgery: Study in 5100 patients. J Cardiovasc Transl Res 2015;8:431-7.
31.	Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784-91.
32.	Schimmel JJ, Horsting PP, de Kleuver M, Wonders G, van Limbeek J. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 2010;19:1711-9.
33.	Nicholson M, Beal M, Shofer F, Brown DC. Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: A retrospective study of 239 dogs and cats. Vet Surg 2002;31:577-81.
34.	Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 2008;90:62-9.
35.	Wang T, Wang H, Yang DL, Jiang LQ, Zhang LJ, Ding WY, et al. Factors predicting surgical site infection after posterior lumbar surgery: A multicenter retrospective study. Medicine (Baltimore) 2017;96:e6042.
36.	Nagaria T, Kujur A, Thakur N. Incision length: An emerging risk factors for surgical-site infection following cesarean section. Int J Reprod Contracept Obstet Gynecol 2017;6:1829-33.

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