Large variations in the practice patterns of surgical antiseptic preparation solutions in patients with open and closed extremity fractures : a cross-sectional survey
Jurado-Ruiz, Maria (Hospital Universitari Vall d'Hebron)
Slobogean, Gerard P. (University of Maryland School of Medicine. R Adams Cowley Shock Trauma Center, Department of Orthopaedics)
Bzovsky, Sofia (McMaster University. Division of Orthopaedic Surgery, Department of Surgery)
Garibaldi, Alisha (McMaster University. Division of Orthopaedic Surgery, Department of Surgery)
O'Hara, Nathan N. (University of Maryland School of Medicine. R Adams Cowley Shock Trauma Center, Department of Orthopaedics)
Howe, Andrea (University of Maryland School of Medicine. R Adams Cowley Shock Trauma Center, Department of Orthopaedics)
Petrisor, Brad (McMaster University. Division of Orthopaedic Surgery, Department of Surgery)
Sprague, Sheila (McMaster University (Canadà))
Universitat Autònoma de Barcelona

Date:	2018
Abstract:	Surgically-managed fractures, particularly open fractures, are associated with high rates of surgical site infections (SSIs). To reduce the risk of an SSI, orthopaedic surgeons routinely clean open fracture wounds in the emergency department (ED) and then apply a bandage to the open wound. Prior to the surgical incision, it is standard practice to prepare the fracture region with an antiseptic skin solution as an additional SSI prevention strategy. Multiple antiseptic solutions are available. To explore the variation in practice patterns among orthopaedic surgeons regarding antiseptic solution use in the ED and antiseptic preparatory techniques for fracture surgery. We developed a 27-item survey and surveyed members of several orthopaedic associations. Two hundred and-ten surveys were completed. 71. 0% of respondents irrigate the open wound and skin in the ED, primarily with saline alone (59. 7%) or iodine-based solutions (32. 9%). 90. 5% of responders indicated that they dress the open wound in the ED, with 41. 0% applying a saline-soaked bandage and 33. 7% applying an iodine-soaked dressing (33. 7%). In their surgical preparation of open fractures, 41. 0% of respondents used an iodine-based solution, 26. 7% used a chlorhexidine gluconate (CHG)-based solution, and 31. 4% used a combination of the two. In closed fractures, 43. 8% of respondents used a CHG-based solution, 28. 1% used an iodine-based solution, and 27. 1% used a combination. Despite theoretical concerns about the use of alcohol in open wounds, 51. 4% used alcohol-based solutions or alcohol alone during skin preparation of open fractures. A lack of consensus exists regarding use of antiseptic surgical preparation solutions for fractures. High-quality clinical research is needed to assess the effectiveness of different surgical antiseptic preparation solutions on patient outcomes in fracture populations. The online version of this article (10. 1186/s13756-018-0440-z) contains supplementary material, which is available to authorized users.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Survey ; Open fracture ; Closed fracture ; Antiseptic preparation ; Surgical site infection ; Surgical preparation ; Antiseptic solution
Published in:	Antimicrobial resistance and infection control, Vol. 7 (november 2018) , ISSN 2047-2994

DOI: 10.1186/s13756-018-0440-z
PMID: 30519462

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