Bacterial skin recolonization in the operating room: comparison between various antisepsis protocols

Area of Science:

• Microbiology
• Infectious Diseases
• Surgical Safety

Background:

• Surgical site infections (SSIs) are often linked to the patient's own skin bacteria.
• Current perioperative skin disinfection practices lack universal agreement.

Purpose of the Study:

• To quantitatively compare different antisepsis and skin protection protocols.
• To assess bacterial recolonization on the skin at regular intervals in the operating room.
• To determine if any protocol is superior in preventing bacterial regrowth.

Main Methods:

• A prospective interventional study involving healthy volunteers undergoing orthopedic surgery.
• Randomized assignment to various preoperative skin preparation protocols including showers, mechanical cleansing, antiseptics (alcoholic Bétadine™ 5% or chlorhexidine 0.5%), sterile draping, and adhesive drapes (Steri-Drape™ or Ioban2™).
• Skin sampling via swabbing at 30-minute intervals up to 90 minutes post-draping, with subsequent aerobic and anaerobic bacterial cultures and quantitative analysis (cfu/mL).

Main Results:

• Bacterial load was significantly higher in males pre-procedure, irrespective of other factors like smoking or BMI.
• All tested protocols showed a significant increase in bacterial load up to 90 minutes post-draping.
• No statistically significant difference in efficacy was observed between the protocols, although the Bétadine™/Ioban™ combination showed the lowest bacterial load at 90 minutes.

Conclusions:

• None of the evaluated perioperative skin preparation protocols demonstrated superiority in immediate bacterial reduction or prevention of skin recolonization.
• Further research is essential to develop consensus-based protocols for effective SSI risk management.