COMPARISON OF INTRAOPERATIVE WOUND IRRIGATION WITH AQUEOUS POVIDONE-IODINE SOLUTION TO NORMAL SALINE IN PREVENTING SURGICAL SITE INFECTIONS
Keywords:Surgical Site Infection, Normal Saline, Povidone-Iodine, Irrigation, Wound Closure
AbstractBackground: A surgical site infection (SSI) is a wound infection caused by pathogens, particularly bacteria, that occurs within 30 days of the surgery. Various methods have been employed in order to minimize the rates of infection one of which is intra-operative wound irrigation. This study aims to compare the frequency of surgical site infections after wound irrigation of contaminated and dirty wounds with normal saline and aqueous povidone-iodine solutions. Methods: This randomized controlled trial was carried out in the surgical department of Federal Government Polyclinic Hospital from January to December 2022. A total of 180 patients were randomly divided into two equal groups using blocked randomization. Group A had normal saline irrigation while Group B had aqueous povidone-iodine irrigation before surgical incision closure. Patients were followed till 30th post-operative day. Data was collected, entered and analyzed using SPSS 20.0. Results: A total of 180 patients were recruited in this study, equally divided into Group A and Group B with 90 patients each. Fifty-three patients (58.9%) from group-A and 58 patients (64.4%) from group-B were having contaminated wounds and 37 patients (41.1%) and 32 patients (35.6%) had dirty wounds respectively. Surgical site infection was found in 29 patients (32.2%) of group-A and 26 patients (28.8%) of group-B (p=0.627). there was no significant difference between the two groups with respect to surgical site infection. Conclusion: Irrigation of surgical wounds with aqueous povidone-iodine solution before primary closure was statistically similar to normal saline in preventing surgical site infections in contaminated and dirty wounds.
Khan R, Asghar MU, Siyar F, Saleem MM, Safdar MH. Role of per-operative wound irrigation in prophylaxis of surgical site infection in clean contaminated wounds. Pak Armed Forces Med J 2019;69(1):60–4.
Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect 2017;18(6):722–35.
Baracs J, Huszár O, Sajjadi SG, Horváth ÖP. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS II): a randomized multicenter study. Surg Infect 2011;12(6):483–9.
Barbadoro P, Marmorale C, Recanatini C, Mazzarini G, Pellegrini I, D'Errico MM, et al. May the drain be a way in for microbes in surgical infections? Am J Infect Control 2016;44(3):283–8.
Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database of Syst Rev 2016;11(11):CD011426.
Grover A, Singh A, Sidhu DS. A prospective randomized trial of open wound treatment vs occlusive dressings in elective surgical cases with respect to surgical site infections. J Clin Diagn Res 2015;9(6):PC26.
Edmiston Jr CE, Leaper DJ. Intra-Operative surgical irrigation of the surgical incision: what does the future Hold—Saline, antibiotic agents, or antiseptic agents? Surg Infect 2016;17(6):656–64.
Edmiston Jr CE, Spencer M, Leaper D. Antiseptic irrigation as an effective interventional strategy for reducing the risk of surgical site infections. Surg Infect 2018;19(8):774–80.
de Jonge SW, Boldingh QJ, Solomkin JS, Allegranzi B, Egger M, Dellinger EP, et al. Systematic review and meta-analysis of randomized controlled trials evaluating prophylactic intra-operative wound irrigation for the prevention of surgical site infections. Surg Infect 2017;18(4):508–19.
Pianka F, Mihaljevic AL. Prevention of postoperative infections: Evidence-based principles. Chirurg 2017;88(5):401–7.
Elsolh B, Zhang L, Patel SV. The effect of antibiotic-coated sutures on the incidence of surgical site infections in abdominal closures: a meta-analysis. J Gastrointest Surg 2017;21(5):896–903.
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(8):784–91.
WHO. Global guidelines for the prevention of surgical site infection, 2nd ed. World Health Organization. 2018.
Chundamala J, Wright JG. The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review. Can J Surg 2007;50(6):473–81.
Maemoto R, Noda H, Ichida K, Tamaki S, Kanemitsu R, Machida E, et al. Superiority trial comparing intraoperative wound irrigation with aqueous 10% povidone–iodine to saline for the purpose of reducing surgical site infection after elective gastrointestinal surgery: study protocol for a randomised controlled trial. BMJ Open 2021;11(6):e051374.
López-Cano M, Kraft M, Curell A, Puig-Asensio M, Balibrea J, Armengol-Carrasco M, et al. A meta-analysis of prophylaxis of surgical site infections with topical application of povidone iodine before primary closure. World J Surg 2019;43(2):374–84.
Mueller TC, Loos M, Haller B, Mihaljevic AL, Nitsche U, Wilhelm D, et al. Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2015;400(2):167–81.
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