Prospective Randomized Trial Comparing the Efficacy of Surgical Preparation Solutions in Hand Surgery.
BACKGROUND
Decontamination of the skin prior to incision is part of the standard of care for any surgical procedure. Previous studies have demonstrated variable efficacy of different surgical preparation solutions based on anatomic location. The purpose of this study is to determine the effectiveness of 3 commonly used surgical preparation solutions in eliminating bacteria from the skin prior to incision for common elective soft tissue hand procedures.


METHODS
A total of 240 patients undergoing clean, elective, soft tissue hand surgery were prospectively randomized to 1 of 3 groups (ChloraPrep, DuraPrep, or Betadine). Prepreparation and postpreparation cultures were obtained adjacent to the surgical incision and neutralization was performed on the obtained specimen. Cultures were held for 14 days and patients followed for 6 weeks postoperatively.


RESULTS
Postpreparation cultures were positive in 21 of 80 (26.3%) ChloraPrep patients, 3 of 79 (3.8%) DuraPrep patients, and 1 of 81 (1.2%) Betadine patients ( P < .001). There was no difference in the postpreparation culture rate between DuraPrep and Betadine ( P = 1.000).


CONCLUSIONS
Duraprep and Betadine were found to be superior to Chloraprep for skin decontamination prior to clean elective soft tissue hand surgery. The bacterial flora of the hand was found to be different from those of the shoulder and spine. The clinical significance of this finding requires clinical consideration because the majority of prepreparation and postpreparation positive cultures were of Bacillus species, which are rarely a cause of postoperative infections.
['Xu|Peter Z|PZ|', 'Fowler|John R|JR|', 'Goitz|Robert J|RJ|']
D019840:2-Propanol D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000891:Anti-Infective Agents, Local D001419:Bacteria D002710:Chlorhexidine D005260:Female D006225:Hand D006235:Hand Disinfection D006801:Humans D007455:Iodine D008297:Male D008875:Middle Aged D019637:Orthopedic Procedures D011206:Povidone-Iodine D011300:Preoperative Care D011446:Prospective Studies D012867:Skin D013530:Surgical Wound Infection D055815:Young Adult
preparation solution ChloraPrep DuraPrep Betadine