Retrospective evaluation of an Iodophor-Incorporated Antimicrobial Plastic Adhesive Wound Drape

Retrospective Evaluation of an Iodophor- Incorporated Antimicrobial Plastic Adhesive Wound Drape MERRILL A. RITTER, MD.,' AND ELAINE D. CAMPBELL, BS. The incidence of postoperative wound infection following the use of III iodoph ‘Incorporated ud- liesive wound drape with I prellmlnlry one-minute Ilcohol cleanse vvls observed in 649 Iotnl arthro- plasties. The patients were followed for 1 mini- mum of one year to detect signs of infection. An infection nte of 0.46% was comparable to the in- cidence previously observed for collve onal methods using on iodine spray is a skin pre- parution. The ultimate goal of a surgical skin prepa- ration is to keep skin bacteria to a minimum and thus reduce the possibility ofa postoper- ative wound infection. The preliminary bac- tericidal agent and surgical drape should work to maintain an antiseptic environment about the wound. Secondary considerations of a preoperative surgical preparation also should include ease of application, time re- quired to apply it, and cost. Other authors concemed with these fac- tors have performed detailed qualitative and quantitative bacterial investigations to deter- mine the antimicrobial efficacy of various skin preparations. Of particular interest is a comparison of the traditional iodophor scrub From the Center for HI]: and Knee Surgery, und In- diana University Medical School, Indianapolis Indiana. - Professor, Onhopaedic surgery. Indiana University Medical School. Reprint requests to Merrill A. Ritler. M.D., the Center for Hip and Knee surgery. 1199 Hadley Road, Moons- villc. IN 45153. Received: September 22. ms. 307 and paint to a one-minute alcohol cleanse used in conjunction with an iodophor-incor- porated adhesive drape. The findings of Geclhoed,‘ Geelhoed er al..’ and Ulrich‘ showed these procedures to be equally effec- tive in reducing the number of bacteria present, with alcohol revealing a significantly higher amount of initial bacteria killed. Fur- thermore, the alcohol cleanse and iodophor- backed drape proved to be superior in meet- ing not only the primary but the secondary objectives of a surgical preparation, provid- ing attractive time and cost savings. This retrospective study evaluates the clin- ical capability of an iodophor-incorporated film to achieve the primary objective of a surgical drape by examining the postopera- tive infection rate following total arthroplas- ties. The results strongly suggest that this skin preparation method is equivalent to tradi- tional methods in reducing the possibility of postoperative wound infections, in addition to providing beneficial time and cost savings. MATERIALS AND METHODS From January 1982 to December I984, iodo- phor-incorporated antimicrobial lilm (Ioban-2 Antimicrobial Film, Medical-Surgical Division, 3M, St. Paul. Minnesota) was routinely applied in conjunction with a preliminary one-minute alco- hol cleanse as preparation for 649 total arthro- plasty recipients (381 hip and 268 knee), which included 40 revisions. Previously infected total anhroplasties were excluded. All patients received 308 Ritter and Campbell ctnat Orlhonlodtcs and Retltafi mnnrat 4% hours of cephalosporin beginning 30 minutes before surgery and were operated upon in a hori- zontal laminar air flow operating room (300 air changes/hour) without the use of hooded exhaust equipment. The patients were followed for a minimum of one year after surgery to detect any indication of postoperative infection. An infection consisted of a draining wound and/or a positive culture from the joint itself. No cultures were made ofthe skin at any time during the procedure. RESU LTS Of the 649 total arthroplasties performed using the loban-2 drape. only three infec- tions (0.46%) were encountered. All three in- fections were from primary operations. Two infections were Staphylococcus aureux, one appearing at two weeks in a total knee arthroplasty recipient, and the other appear- ing at five months in a total hip arthroplasty recipient. The third infection was Staphylo- coccus epidermidir and was evident 15 days following a total knee arthroplasty. DISCUSSION The results of this study are self-evident. The plastic iodophor-backed drape, when used in conjunction with a preliminary alco- hol cleanse. is an excellent method of surgi- cal skin preparation. Not only does the easy preparation method supply suflicient anti- microbial action at the surgical site."“ but the application advantage of the drape is not offset by an elevated infection rate. in fact, the exceptional postoperative infection rate of0.46% observed in this study parallels the rate of 0.42% found in a previous study in- volving a conventional polymer-iodine spray as a skin preparation? Furthermore, the Ioban-2 drape used in this study requires only a one-minute alcohol cleanse. eliminat- ing the requirement for a preliminary anti- septic scrub. thus providing time and cost advantages without sacrificing sterility. REFERENCES 1 Geelhoed. G. w.. Preupcrntite skin prr:p1.tr1llIun' Evaluation of errrcacy. liming. CmIvt‘nrL‘m'C. and cost. Infections in Surgery 4:648, ms. 2. Geelhoed, 0. w., shnrpe, r