Efficacy of forefoot scrubbing with bristled brush during foot and ankle surgery

The utility of forefoot cleaning using bristled brush has been proposed by previous studies but has not been tested in any study. The aim of the current study is to investigate the antiseptic efficacy of additional forefoot scrubbing with bristled brush after a standard 2-step preparation with alcohol and chlorhexidine in foot and ankle surgery.

One hundred patients underwent foot and ankle surgery by one orthopedic surgeon were included and categorized into one of two groups of different skin preparation procedure before surgery. Group 1 is the control group which received a standard 2-step preparation with alcohol and chlorhexidine. Group 2 is the forefoot scrubbing group which received a standard preparation with alcohol and chlorhexidine and an additional forefoot scrubbing in a sterile fashion. Positive culture results and microbe species were primary outcomes. A secondary outcome was the occurrence of any surgical site infection (SSI) 12 months following surgery.

The hallux nail fold positive rate of the forefoot scrubbing group was significantly lower than that of the control group after draping (forefoot scrubbing group, 0 %; control group, 12 %; p = 0.027) and after surgery (forefoot scrubbing group, 6 %; control group, 28 %; p = 0.003). The microbe species of hallux nail fold after surgery included Staphylococcus, coagulase negative, Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus luteus, Neisseria, and Corynebacterium afermentans. There was no difference in the rate of SSI between the forefoot scrubbing group (10 %) and the control group (6 %).

Forefoot scrubbing with bristled brush before foot and ankle surgery reduces microbe growth rate after draping and after surgery at hallux nail fold.

Level II, prospective cohort study.