PRİMER TOTAL DİZ ARTROPLASTİSİNDE, KLORHEKSİDİN GLUKONAT VE POVİDON İYOTUN CERRAHİ ALAN ENFEKSİYONUNA ETKİNLİĞİNİN KARŞILAŞTIRILMASI
Abstract
Amaç
Hasta cildi patojen mikroorganizmalar için majör bir
kaynaktır. Cerrahi öncesinde, cilt temizliğinin antiseptiklerle
yapılarak bu patojenlerin cerrahi alandan uzaklaştırılması
standart bir yöntemdir. Klorheksidin glukonat
(KG) ve Povidon iyot (Pİ) bu amaç için önerilen
iki farklı antiseptiktir. Bu antiseptiklerin kontamine cerrahilerdeki
etkinliğini gösteren çok sayıda çalışma olmasına
rağmen, temiz cerrahilerdeki etkinliğini bildiren
çalışmalar kısıtlıdır. Bu çalışmada, temiz cerrahi olan
primer total diz artroplastisinde klorheksidin glukonatın
cerrahi alan enfeksiyonuna etkinliğinin povidon iyot ile
karşılaştırılması amaçlandı.
Gereç ve Yöntem
Cerrahi alan cilt temizliğinde KG (110 hasta) ve Pİ
(135 hasta) kullanılan toplam 245 primer total diz artroplastisi
hastasının verileri incelendi. Hastalar kullanılan
antiseptiğe göre KG grubu ve Pİ grubu olarak 2
gruba ayrıldı. Grupların demografik özellikleri benzerdi
(p>0,05). KG grubunda, cerrahi alandan cerrahi öncesi
ve sonrasında alınan sürüntü örnekleri mikrobiyolojik
olarak incelendi ve çalışmanın birincil sonucu
olarak KG’nin cerrahi alan asepsisine anlık etkinliği
değerlendirildi. Her iki grupta cerrahi alanda gelişen
enfeksiyon komplikasyonu; yüzeyel enfeksiyon (minör
komplikasyon) ve derin enfeksiyon (majör komplikasyon)
olarak kaydedildi. Çalışmanın ikincil sonucu olarak
cerrahi alan komplikasyonları her iki grup arasında
karşılaştırıldı.
Bulgular
KG kullanılmadan önce cerrahi alandan alınan sürüntü
örneklerinin hepsinde en az bir patojen mikroorganizma
ürerken, KG kullanıldıktan sonra alınan sürüntü
örneklerinin hiçbirinde üreme olmadı. KG ve Pİ grubunda
cerrahi alan komplikasyonları sırasıyla; minör
komplikasyonlar (%4,54 ve %5,18) ve majör komplikasyonlar
(%0,9 ve %1,8) olarak bulundu. Minör ve
majör komplikasyonlar açısından gruplar arasında
istatistiksel anlamlı fark bulunmadı (p>0,05). Çalışmanın
birincil sonucunda, primer total diz artroplastisinde
klorheksidin glukonat kullanıldığında cerrahi alanda
tam bir asepsi oluşturmaktadır ve ikincil sonuç olarak
cerrahi alan enfeksiyonuna etkinliği açısından klorheksidin
glukonatın povidon iyot ile karşılaştırılmasında
gruplar arasında fark olmadığı sonucu elde edildi.
Sonuç
Bu çalışma temiz cerrahi olan primer total diz artroplastisinde
antiseptiklerin etkinliğini değerlendiren nadir
çalışmalardan biridir. Primer total diz artroplastisinde
klorheksidin glukonat kullanıldığında cerrahi alanda
tam bir asepsi oluşturmaktadır ve cerrahi alan enfeksiyonunu
önlemede povidon iyot gibi etkindir.
Keywords
Asepsi Cerrahi alan enfeksiyonu Klorheksidin glukonat Povidon iyot Primer total diz artroplastisi
References
- 1. Kapadia BH, Elmallah RK, Mont MA. A Randomized, Clinical Trial of Preadmission Chlorhexidine Skin Preparation for Lower Extremity Total Joint Arthroplasty. J Arthroplasty. 2016 Dec;31(12):2856-2861. doi: 10.1016/j.arth.2016.05.043.
- 2. Bozic KJ, Grosso LM, Lin Z, et al. Variation in hospital-level risk-standardized complication rates following elective primary total hip and knee arthroplasty. J Bone Joint Surg Am 2014;96(8):640.
- 3. Frank RM, Cross MB, Della Valle CJ. Periprosthetic joint infection: modern aspects of prevention, diagnosis, and treatment. J Knee Surg 2015;28(2):105).
- 4. Parvizi J, Pawasarat IM, Azzam KA, et al. Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty 2010;25(6 Suppl):103
- 5. Darouiche RO, Wall Jr MJ, Itani KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):18.
- 6. Kuyyakanond T, Quesnel LB. The mechanism of action of chlorhexidine. FEMS Microbiol Lett 1992;100(1-3):211.
- 7. Napolitano LM. Decolonization of the skin of the patient and surgeon. Surg Infect (Larchmt) 2006;7:Suppl 3:S3-S15.
- 8. Ayoub F, Quirke M, Conroy R, et al. Chlorhexidine-alcohol versus povidone- iodine for pre-operative skin preparation: a systematic review and meta- analysis. Int J Surg Open. 2015;1:41–46
- 9. Sızlan A, Dündaröz R, Dabak M, Yıldıran T, Dağlı G, Özyurt M. Povidon – İyot Solüsyonlarının Güvenilirliği. SDÜ Tıp Fakültesi Dergisi. 2001;8(1):14-17
- 10. Rackur H,New aspects of mechanism of action of povidone-iodine. J Hosp Infect. 1985 Mar;6 Suppl A:13-23. doi: 10.1016/ s0195-6701(85)80041-4.
- 11. Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon JK, Wa CTC, Villa MA. Povidone iodine in wound healing: A review of current concepts and practices. Int J Surg. 2017 Aug;44:260-268. doi: 10.1016/j.ijsu.2017.06.073.
- 12. Ellanti P, Hurson C. Tourniquet-associated povidone-iodine- induced chemical burns. BMJ Case Rep. 2015 Mar 5;2015:bcr2014208967. doi: 10.1136/bcr-2014-208967.
- 13. Nahlieli O, Baruchin AM, Levi D, Shapira Y, Yoffe B. Povidone- iodine related burns. Burns. 2001 Mar;27(2):185-8. doi: 10.1016/s0305-4179(00)00081-4.
- 14. Yang JH, Lim H, Yoon JR, Jeong HI. Tourniquet associated chemical burn. Indian J Orthop. 2012 May;46(3):356-9. doi: 10.4103/0019-5413.96366.
- 15. Edwards PS, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev 2004; CD003949.
- 16. Cho MR, Choi WK, Che SH, Song SK. Efficacy of skin preparation solutions in patients with total knee replacement: A randomized controlled trial. J Orthop Surg (Hong Kong). 2023 Jan-Apr;31(1):10225536231165358. doi: 10.1177/10225536231165358.
- 17. Peel TN, Watson E, Lee SJ. Randomised Controlled Trials of Alcohol-Based Surgical Site Skin Preparation for the Prevention of Surgical Site Infections: Systematic Review and Meta- Analysis. J Clin Med. 2021 Feb 9;10(4):663. doi: 10.3390/ jcm10040663.
- 18. Bibbo C, Patel DV, Gehrmann RM, Lin SS. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res. 2005 Sep;438:204-8. doi: 10.1097/01.blo.0000167832.47464.22.
- 19. Gibson A,TevisS,Kennedy G. Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program. Am J Surg. 2014; 207:832–839.
- 20. World Health Organization (WHO). Protocol for Surgical Site Infection Surveillance With a Focus on Settings With Limited Resources. 2018. Available at: http://www.who.int/infection- prevention/tools/surgical/SSI-surveillance- protocol.pdf. Accessed February 26, 2020.
COMPARISON OF THE EFFECTIVENESS OF CHLORHEXIDINE GLUCONATE AND POVIDONE IODINE ON SURGICAL SITE INFECTION IN PRIMARY TOTAL KNEE ARTHROPLASTY
Abstract
Objective
Patient skin is a major source for pathogenic
microorganisms. Before surgery, it is a standard
method to clean the skin with antiseptics and remove
these pathogens from the surgical area. Chlorhexidine
gluconate (CG) and Povidone iodine (PI) are two
different antiseptics recommended for this purpose.
Although there are many studies showing the
effectiveness of these antiseptics in contaminated
surgeries, studies reporting their effectiveness in clean
surgeries are limited. In this study, it was aimed to
compare the effectiveness of chlorhexidine gluconate
on surgical site infection with povidone iodine in primary
total knee arthroplasty, which is a clean surgery.
Material and Method
The data of a total of 245 primary total knee
arthroplasty patients who used CG (110 patients) and
PI (135 patients) for surgical site skin cleansing were
analyzed. The patients were divided into 2 groups as
KG group and PI group according to the antiseptic
used. Demographic characteristics of the groups were
similar (p>0.05). In the KG group, swab samples taken
from the surgical field before and after surgery were
microbiologically examined and the immediate efficacy
of chlorhexidine gluconate on surgical site asepsis
was evaluated as the primary outcome of the study.
Complication of infection in the surgical field in both
groups; superficial infection (minor complication) and
deep infection (major complication) were recorded.
As a secondary outcome of the study, surgical site
complications were compared between both groups.
Results
At least one pathogenic microorganism was grown in
all swab samples taken from the surgical area before
the use of CG, while there was no growth in any of the
swab samples taken after using CG. Complications of
the surgical field in the KG and PI groups, respectively;
minor complications (4.54% vs. 5.18%) and major
complications (0.9% vs. 1.8%) were found. There
was no statistically significant difference between the
groups in terms of minor and major complications
(p>0.05). In the primary result of the study, when
chlorhexidine gluconate is used in primary total
knee arthroplasty, it creates complete asepsis in the
surgical field, and as a secondary result, there is no
difference between the groups in the comparison of
chlorhexidine gluconate with povidone iodine in terms
of its effectiveness in surgical site infection.
Conclusion
This study is one of the rare studies evaluating the
efficacy of antiseptics in primary total knee arthroplasty,
which is a clean surgery. When chlorhexidine
gluconate is used in primary total knee arthroplasty,
it creates complete asepsis in the surgical area and is
as effective as povidone iodine in preventing surgical
site infection.
Keywords
Asepsis Chlorhexidine gluconate Povidone iodine Primary total knee arthroplasty Surgical site infection
References
- 1. Kapadia BH, Elmallah RK, Mont MA. A Randomized, Clinical Trial of Preadmission Chlorhexidine Skin Preparation for Lower Extremity Total Joint Arthroplasty. J Arthroplasty. 2016 Dec;31(12):2856-2861. doi: 10.1016/j.arth.2016.05.043.
- 2. Bozic KJ, Grosso LM, Lin Z, et al. Variation in hospital-level risk-standardized complication rates following elective primary total hip and knee arthroplasty. J Bone Joint Surg Am 2014;96(8):640.
- 3. Frank RM, Cross MB, Della Valle CJ. Periprosthetic joint infection: modern aspects of prevention, diagnosis, and treatment. J Knee Surg 2015;28(2):105).
- 4. Parvizi J, Pawasarat IM, Azzam KA, et al. Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty 2010;25(6 Suppl):103
- 5. Darouiche RO, Wall Jr MJ, Itani KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):18.
- 6. Kuyyakanond T, Quesnel LB. The mechanism of action of chlorhexidine. FEMS Microbiol Lett 1992;100(1-3):211.
- 7. Napolitano LM. Decolonization of the skin of the patient and surgeon. Surg Infect (Larchmt) 2006;7:Suppl 3:S3-S15.
- 8. Ayoub F, Quirke M, Conroy R, et al. Chlorhexidine-alcohol versus povidone- iodine for pre-operative skin preparation: a systematic review and meta- analysis. Int J Surg Open. 2015;1:41–46
- 9. Sızlan A, Dündaröz R, Dabak M, Yıldıran T, Dağlı G, Özyurt M. Povidon – İyot Solüsyonlarının Güvenilirliği. SDÜ Tıp Fakültesi Dergisi. 2001;8(1):14-17
- 10. Rackur H,New aspects of mechanism of action of povidone-iodine. J Hosp Infect. 1985 Mar;6 Suppl A:13-23. doi: 10.1016/ s0195-6701(85)80041-4.
- 11. Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon JK, Wa CTC, Villa MA. Povidone iodine in wound healing: A review of current concepts and practices. Int J Surg. 2017 Aug;44:260-268. doi: 10.1016/j.ijsu.2017.06.073.
- 12. Ellanti P, Hurson C. Tourniquet-associated povidone-iodine- induced chemical burns. BMJ Case Rep. 2015 Mar 5;2015:bcr2014208967. doi: 10.1136/bcr-2014-208967.
- 13. Nahlieli O, Baruchin AM, Levi D, Shapira Y, Yoffe B. Povidone- iodine related burns. Burns. 2001 Mar;27(2):185-8. doi: 10.1016/s0305-4179(00)00081-4.
- 14. Yang JH, Lim H, Yoon JR, Jeong HI. Tourniquet associated chemical burn. Indian J Orthop. 2012 May;46(3):356-9. doi: 10.4103/0019-5413.96366.
- 15. Edwards PS, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev 2004; CD003949.
- 16. Cho MR, Choi WK, Che SH, Song SK. Efficacy of skin preparation solutions in patients with total knee replacement: A randomized controlled trial. J Orthop Surg (Hong Kong). 2023 Jan-Apr;31(1):10225536231165358. doi: 10.1177/10225536231165358.
- 17. Peel TN, Watson E, Lee SJ. Randomised Controlled Trials of Alcohol-Based Surgical Site Skin Preparation for the Prevention of Surgical Site Infections: Systematic Review and Meta- Analysis. J Clin Med. 2021 Feb 9;10(4):663. doi: 10.3390/ jcm10040663.
- 18. Bibbo C, Patel DV, Gehrmann RM, Lin SS. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res. 2005 Sep;438:204-8. doi: 10.1097/01.blo.0000167832.47464.22.
- 19. Gibson A,TevisS,Kennedy G. Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program. Am J Surg. 2014; 207:832–839.
- 20. World Health Organization (WHO). Protocol for Surgical Site Infection Surveillance With a Focus on Settings With Limited Resources. 2018. Available at: http://www.who.int/infection- prevention/tools/surgical/SSI-surveillance- protocol.pdf. Accessed February 26, 2020.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences, Health Care Administration |
| Journal Section | Araştırma Makaleleri |
| Authors | |
| Publication Date | September 23, 2023 |
| Submission Date | May 2, 2023 |
| Acceptance Date | August 13, 2023 |
| Published in Issue | Year 2023 Volume: 30 Issue: 3 |
Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi/Medical Journal of Süleyman Demirel University is licensed under Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International.