Skin Preparation in Prevention of Surgical Site Infection in Paediatric Abdominal Surgeries at The University of Port Harcourt Teaching Hospital, Nigeria.
DOI:
https://doi.org/10.47941/ijhmnp.1405Keywords:
Povidone-Iodine/alcohol, Chlorhexidine/alcohol, Surgical Site Infection, Paediatric Clean-Contaminated WoundAbstract
Purpose: Many studies on preoperative antiseptic agents are inconclusive. This study attempts to find the more effective combination antiseptic agent in pediatric surgical patients.
Methodology: This was a prospective randomized study on paediatric patients. Preoperative skin preparation for each group was done with the assigned antiseptic combination. Patients were followed up on the 14th,21st and 30th postoperative days. The primary outcome measures were the incidence of SSI in both groups, Secondary outcome measures was the prevalent flora in patients with SSI. The data from the folders were collected and collated. A ninety-five percent confidence interval and a p-value less than 0.05 was considered significant. Continuous variables were presented in means and standard deviation. Results were presented in tables.
Findings: The rate of SSI in the chlorhexidine–alcohol group was 6.9% and that of the povidone–iodine/alcohol group was 9.7%. The odds ratio was 0.71 in favour of the chlorhexidine/alcohol group, but the result was not statistically significant(p=0.228) Organisms isolated were mostly monomicrobial, with Escherichia coli accounting for 50% of the cases.
Unique Contributions to Theory, Policy and Practice: The study found that the patients who received chlorhexidine–alcohol as a skin antiseptic had a lower incidence of SSI than those who received povidone-iodine/alcohol; however, this was not statistically significant. Earlier studies had initially stated that the povidone-iodine/alcohol was better.
Downloads
References
Cui P, Fang X. Pathogenesis of Infection in Surgical Patients. Curr Opin Crit Care. 2015; 21:343-350.
Singh R, Singla P, Chaudhury U. Surgical Site Infections: Classification, Risk Factors Pathogenesis and Preventive Management. Intl. J. Pharm. Res. Health Sci. 2014; 2:203-214.
Berrios-Torres S, Umscheid CA, Bratzler DW. Healthcare Infection Control Practices Advisory Committee. Centres for Disease Control and Prevention guideline for the prevention of surgical site infection. JAMA Surgery. 2017; 152:784-791.
Anderson DJ, Podgorny K, Berrios-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect. Contrl& Hosp. Epidemiol. 2014; 35: S66-88.
Leaper DJ, Van Goor H, Reilly J, Petrosillo N, Geiss HK, Torres AJ, et al. Surgical site infection–a European perspective of incidence and economic burden. Intl. wound J. 2004; 1:247-73.
Takesue Y, Watanabe A, Kusachi S, Matsumoto T, Iwamoto A, Totsuka K, et al. Nationwide surveillance of antimicrobial susceptibility patterns of pathogens isolated from surgical site infections (SSI) in Japan. J. Infect Chemother. 2012; 18:816-26.
Fan Y, Wei Z, Wang W, Tan L, Jiang H, Tian L, et al.The incidence and distribution of surgical site infection in mainland China: a meta-analysis of 84 prospective observational studies. Sci. Reports. 2014; 4:67-83.
Olowo-Okere A, Ibrahim YK, Olayinka BO, Ehinmidu JO. Epidemiology of surgical site infections in Nigeria: A systematic review and meta-analysis. Nig. Postgrad. Med. J.2019; 26:143-151.
Anderson DJ, Sexton DJ, Kanafani ZA, Auten G, Kaye KS. Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect. Contrl. And Hosp. Epidemiol. 2007; 28:1047-1053.
Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Alnawawi A, Maghrabi A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Can. J. Surg. 2019; 62:111-118.
Brisibe SF, Ordinioha B, Gbeneolol PK. The effect of hospital infection control policy on the prevalence of surgical site infection in a tertiary hospital in South-South Nigeria. Nigerian Medical Journal: Journal of the Nigeria Medical Association. 2015 May;56(3):194.
Ogba Azubuike, Abhulimen Victor. Surgical Site Infection Following Laparotomy, Is There A Role for Surgical Incise Drapes? IOSR Journal of Dental and Medical Sciences. 2022 August;21(8):42-48.
Ademuyiwa AO, Hardy P, Runigamugabo E, Sodonougbo P, Behanzin H, Kangni S, Agboton G, Adagrah LA, Adjei-Acquah E, Acquah AO, Ankomah J. Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial. The Lancet. 2021 Nov 6;398(10312):1687-99.
Abdeyazdan Z, Majidipour N, Zargham-Boroujeni A. Comparison of the effects of povidone-iodine and chlorhexidine solutions on skin bacterial flora among hospitalized infants. J Edu. health Prom. 2014; 3:87-92.
Park HM, Han SS, Lee EC, Lee SD, Yoon HM, Eom BW. A randomized clinical trial of preoperative skin antisepsis with chlorhexidine gluconate or povidone–iodine. Brit. J. Surg.2017; 104:145-150.
Srinivas A, Kaman L, Raj P, Gautam V, Dahiya D, Singh G, et al.Comparison of the efficacy of chlorhexidine gluconate versus povidone-iodine as preoperative skin preparation for the prevention of surgical site infections in clean-contaminated upper abdominal surgeries. Surg. Today. 2015; 45:1378-1384.
Darouiche RO, Wall Jr MJ, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. New Eng. J. Med.2010; 362:18-26.
Barie PS, Surgical site infections: epidemiology and prevention. Surgical infections.2002;3: 9-21.
Swenson BR, Hedrick TL, Metzger R, Bonatti H, Pruett TL, Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infect Control Hosp Epidemiol. 2009:30:964-971.
CharehbiliA, SwijnenburgRJ, Van de Velde C, Van den Bremer J, VanGijn W. A retrospective analysis of surgical site infections after chlorhexidine -alcohol versus iodine -alcohol for pre-operative antisepsis. Surgical Infections.2014;15:310-313.
Dörfel D, Maiwald M, Daeschlein G, Müller G, Hudek R, Assadian O, et al. Comparison of the antimicrobial efficacy of povidone-iodine-alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic skin flora of the shoulder region. Antimicrobial Resistance & Infection Control. 2021; 10:1-9.
Sidhwa F, Itani KM. Skin preparation before surgery: options and evidence. Surgical infection .2015;16:14-23.
Fraser JF, Young SW, Valentine KA, Probst NE, Spangehl MJ. The Gown-glove Interface Is a Source of Contamination: A Comparative Study. Clin. OrthopRelat. Res.2015; 473:2291-2297.
Dessalegn L, Shimelis T, Tadesse E, Gebre-selassie S. Aerobic bacterial isolates from the post-surgical wound and their antimicrobial susceptibility pattern: a hospital-based cross-sectional study. J Med Res. 2014; 3:18-23.
Ameh EA, Mshelbwala PM, Nasir AA, Lukong CS, Jabo BA, Anumah MA, et al. Surgical site infection in children: prospective analysis of the burden and risk factors in a sub-Saharan African setting. Surgic. Infect. 2009; 10:105-109.
Al Maqbali MA. Pre-operative Hair Removal: A Literature Review. Intl. J. Nurs. & Clin. Pract.2016; 3:1-6.
Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, et al. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database System. Rev. 2018; 2:1-80.
Ussiri EV, Mkony CA, Aziz MR. Surgical wound infection in clean-contaminated and contaminated laparotomy wounds at Muhimbili National Hospital. East and Central African Journal of Surgery. 2005;10(2):19-23.
Downloads
Published
How to Cite
Issue
Section
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
