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INFECTION PREVENTION


efficacy and cost of iodine impregnated drapes with standard drapes in cardiac surgery. The SSI rate for each group of patients in the study of 5,100 patients was measured from January 2008 to March 2015. The group which received a standard drape reported a SSI rate of 6.5%. The group of patients which received ioban drapes reported a SSI rate of 1.9%.


A cost analysis further demonstrated that although the upfront cost of a ioban incise drape was greater than a standard incise drape, once the additional costs associated with SSI were accounted for, the use of the ioban incise drapes offered cost savings of 957 euros per patient. Kat Topley also discussed some of the clinical benefits of the use of antimicrobial incise drapes during surgery when compared to non-impregnated incise drapes, which simply immobilise the skin flora as it continues to grow throughout the procedure. “Antimicrobial impregnated incise drapes provide a barrier to bacterial contamination, reducing the risk of bacteria transferring into the surgical wound,” she said. “The antimicrobial impregnated film of the ioban 2 drape ensures constant contact with the patient’s skin, even during irrigation.


“The drapes also provide continuous broad-spectrum antimicrobial activity all the way to the incision edge,’ she continued. “Secure adherence to the skin helps prevent drape lift and prep wash-off, while its low memory stretch allows for limb mobilsation or heavy retraction with reduced tension to the skin.”


Antimicrobial incise drapes have also been found to help reduce the likelihood of skin recolonisation after prepping8


which


reduces the risk of wound contamination by skin flora9


Conclusion


A surgeon would never think about operating without wearing sterile gloves, which in addition to protecting the surgeon, protect the wound from skin flora that may be present on the surgeon’s hands. The same care should be taken to protect the wound from the patient’s own skin flora and the use of a sterile incise drape can provide this protection, helping ensure that the skin remains bacteria-free throughout surgery. Traditional skin preparation leaves the patient vulnerable to its removal or neutralisation during surgery by blood, exudate and irrigation fluids which can result in bacterial


which is a common cause of SSI.10


regeneration on the skin. However, a skin surface that is covered with a sterile incise drape throughout surgery will ensure that no bacterial regeneration takes place, helping to reduce the risk of a SSI.


References


1 Cars O, Nordberg PA. Antibiotic resistance – the faceless threat. International Journal of Risk and Safety in Medicine 2005;17;103-11Q.


2 NICE Clinical Guidelines No CG74. (2008) Surgical site infections: Prevention and treatment. (2008)


3 Centres for Disease Control and Prevention (1999) Guidelines for Prevention of Surgical Site Infection. Hospital Infection Control Practices Advisory Committee.


4 Urban, Hinrichs, Song, Hasley and Garvin. (2001) Skin bacterial counts in patients with a history of infected total join arthroplasty. Amer Acad. Orthop Surg Poster Pres.


5 Casey, Karpanene, Nightingale, Conway and Elliott et al. Antimicrobial activity and skin permeation of iodine present in an iodine-impregnated surgical incise drape. J. Antimicrobial Chemotherapy 2015 Aug;70(8):2255-60.


6 Yoshimura Y, Kubo S, Hirohashi K, Ogawa M, Morimoto K, Shirata K, Kinoshita H. Plastic iodophor drape during liver surgery operative use of the iodophor-impregnated adhesive drape to prevent wound infection during high risk surgery. World J Surg. 2003 Jun;27(6):685-8.


7 Bejko et al. Comparison of Efficacy and Cost of Iodine Impregnated Drape vs. Standard Drape in Cardiac Surgery: Study in 5100 Patients. J Cardiovasc Transl Res. 2015 Oct;8(7):431-7.


8 D. H. Johnston, J. A. Fairclough, et al. 1987 Rate of bacterial recolonization of the skin after preparation: four methods compared Br. J. Surg., Vol. 74, January, page 64.


Antimicrobial incise drapes have also been found to help reduce the likelihood of skin recolonisation after prepping.


46 I WWW.CLINICALSERVICESJOURNAL.COM


9. Professor John Fairclough, Consultant Orthopaedic Surgeon, University Hospital of Wales, Cardiff. 2010 10. Data on file. Tech-Product-Dev-05-000101. Statistical analysis of Ioban incise drape framed delivery focus panel results. 11. Data on file. Clin-Index-Lims 08679.


10 A J Mangram et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infection Control and Hospital Epidemiology 20 (April 1999) 250-278


MARCH 2017


CSJ


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