Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites

Joshua D I Ellenhorn, David D. Smith, Roderich E. Schwarz, Mark H. Kawachi, Timothy G. Wilson, Kathryn F. McGonigle, Lawrence D. Wagman, I. Benjamin Paz

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

BACKGROUND: Antiseptic preoperative skin site preparation is used to prepare the operative site before making a surgical incision. The goal of this preparation is a reduction in postoperative wound infection. The most straightforward technique necessary to achieve this goal remains controversial. STUDY DESIGN: A prospective randomized trial was designed to prove equivalency for two commonly used techniques of surgical skin site preparation. Two hundred thirty-four patients undergoing nonlaparoscopic abdominal operations were consented for the trial. Exclusion criteria included presence of active infection at the time of operation, neutropenia, history of skin reaction to iodine, or anticipated insertion of prosthetic material at the time of operation. Patients were randomized to receive either a vigorous 5-minute scrub with povidone-iodine soap, followed by absorption with a sterile towel, and a paint with aqueous povidone-iodine or surgical site preparation with a povidone-iodine paint only. The primary end point of the study was wound infection rate at 30 days, defined as presence of clinical signs of infection requiring therapeutic intervention. RESULTS: Patients randomized to the scrub-and-paint arm (n = 115) and the paint-only arm (n = 119) matched at baseline with respect to age, comorbidity, wound classification, mean operative time, placement of drains, prophylactic antibiotic use, and surgical procedure (all p > 0.09). Wound infection occurred in 12 (10%) scrub-and-paint patients, and 12 (10%) paint-only patients. Based on our predefined equivalency parameters, we conclude equivalence of infection rates between the two preparations. CONCLUSIONS: Preoperative preparation of the abdomen with a scrub with povidone-iodine soap followed by a paint with aqueous povidone-iodine can be abandoned in favor of a paint with aqueous povidone-iodine alone. This change will result in reductions in operative times and costs.

Original languageEnglish (US)
Pages (from-to)737-741
Number of pages5
JournalJournal of the American College of Surgeons
Volume201
Issue number5
DOIs
StatePublished - Nov 2005

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Paint
Povidone-Iodine
Soaps
Wound Infection
Operative Time
Skin
Arm
Infection
Surgical Wound Infection
Local Anti-Infective Agents
Neutropenia
Iodine
Abdomen
Comorbidity
Anti-Bacterial Agents
Costs and Cost Analysis
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Ellenhorn, J. D. I., Smith, D. D., Schwarz, R. E., Kawachi, M. H., Wilson, T. G., McGonigle, K. F., ... Paz, I. B. (2005). Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites. Journal of the American College of Surgeons, 201(5), 737-741. https://doi.org/10.1016/j.jamcollsurg.2005.05.023

Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites. / Ellenhorn, Joshua D I; Smith, David D.; Schwarz, Roderich E.; Kawachi, Mark H.; Wilson, Timothy G.; McGonigle, Kathryn F.; Wagman, Lawrence D.; Paz, I. Benjamin.

In: Journal of the American College of Surgeons, Vol. 201, No. 5, 11.2005, p. 737-741.

Research output: Contribution to journalArticle

Ellenhorn, JDI, Smith, DD, Schwarz, RE, Kawachi, MH, Wilson, TG, McGonigle, KF, Wagman, LD & Paz, IB 2005, 'Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites', Journal of the American College of Surgeons, vol. 201, no. 5, pp. 737-741. https://doi.org/10.1016/j.jamcollsurg.2005.05.023
Ellenhorn, Joshua D I ; Smith, David D. ; Schwarz, Roderich E. ; Kawachi, Mark H. ; Wilson, Timothy G. ; McGonigle, Kathryn F. ; Wagman, Lawrence D. ; Paz, I. Benjamin. / Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites. In: Journal of the American College of Surgeons. 2005 ; Vol. 201, No. 5. pp. 737-741.
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title = "Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites",
abstract = "BACKGROUND: Antiseptic preoperative skin site preparation is used to prepare the operative site before making a surgical incision. The goal of this preparation is a reduction in postoperative wound infection. The most straightforward technique necessary to achieve this goal remains controversial. STUDY DESIGN: A prospective randomized trial was designed to prove equivalency for two commonly used techniques of surgical skin site preparation. Two hundred thirty-four patients undergoing nonlaparoscopic abdominal operations were consented for the trial. Exclusion criteria included presence of active infection at the time of operation, neutropenia, history of skin reaction to iodine, or anticipated insertion of prosthetic material at the time of operation. Patients were randomized to receive either a vigorous 5-minute scrub with povidone-iodine soap, followed by absorption with a sterile towel, and a paint with aqueous povidone-iodine or surgical site preparation with a povidone-iodine paint only. The primary end point of the study was wound infection rate at 30 days, defined as presence of clinical signs of infection requiring therapeutic intervention. RESULTS: Patients randomized to the scrub-and-paint arm (n = 115) and the paint-only arm (n = 119) matched at baseline with respect to age, comorbidity, wound classification, mean operative time, placement of drains, prophylactic antibiotic use, and surgical procedure (all p > 0.09). Wound infection occurred in 12 (10{\%}) scrub-and-paint patients, and 12 (10{\%}) paint-only patients. Based on our predefined equivalency parameters, we conclude equivalence of infection rates between the two preparations. CONCLUSIONS: Preoperative preparation of the abdomen with a scrub with povidone-iodine soap followed by a paint with aqueous povidone-iodine can be abandoned in favor of a paint with aqueous povidone-iodine alone. This change will result in reductions in operative times and costs.",
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AU - Ellenhorn, Joshua D I

AU - Smith, David D.

AU - Schwarz, Roderich E.

AU - Kawachi, Mark H.

AU - Wilson, Timothy G.

AU - McGonigle, Kathryn F.

AU - Wagman, Lawrence D.

AU - Paz, I. Benjamin

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N2 - BACKGROUND: Antiseptic preoperative skin site preparation is used to prepare the operative site before making a surgical incision. The goal of this preparation is a reduction in postoperative wound infection. The most straightforward technique necessary to achieve this goal remains controversial. STUDY DESIGN: A prospective randomized trial was designed to prove equivalency for two commonly used techniques of surgical skin site preparation. Two hundred thirty-four patients undergoing nonlaparoscopic abdominal operations were consented for the trial. Exclusion criteria included presence of active infection at the time of operation, neutropenia, history of skin reaction to iodine, or anticipated insertion of prosthetic material at the time of operation. Patients were randomized to receive either a vigorous 5-minute scrub with povidone-iodine soap, followed by absorption with a sterile towel, and a paint with aqueous povidone-iodine or surgical site preparation with a povidone-iodine paint only. The primary end point of the study was wound infection rate at 30 days, defined as presence of clinical signs of infection requiring therapeutic intervention. RESULTS: Patients randomized to the scrub-and-paint arm (n = 115) and the paint-only arm (n = 119) matched at baseline with respect to age, comorbidity, wound classification, mean operative time, placement of drains, prophylactic antibiotic use, and surgical procedure (all p > 0.09). Wound infection occurred in 12 (10%) scrub-and-paint patients, and 12 (10%) paint-only patients. Based on our predefined equivalency parameters, we conclude equivalence of infection rates between the two preparations. CONCLUSIONS: Preoperative preparation of the abdomen with a scrub with povidone-iodine soap followed by a paint with aqueous povidone-iodine can be abandoned in favor of a paint with aqueous povidone-iodine alone. This change will result in reductions in operative times and costs.

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