Safe and Effective Skin Antiseptics in Gastrointestinal Surgery
Povidone iodine, alcohol, and chlorhexidine gluconate are commonly used for skin antisepsis in surgical settings. Recently, a randomized controlled trial confirmed the effectiveness of oranexidine, a new skin antiseptic, for this purpose. However, many disinfectants are not recommended for disinfect...
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| Published in | Japanese Journal of Infection Prevention and Control Vol. 38; no. 3; pp. 75 - 79 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
Japanese Society for Infection Prevention and Control
25.05.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1882-532X 1883-2407 |
| DOI | 10.4058/jsei.38.75 |
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| Abstract | Povidone iodine, alcohol, and chlorhexidine gluconate are commonly used for skin antisepsis in surgical settings. Recently, a randomized controlled trial confirmed the effectiveness of oranexidine, a new skin antiseptic, for this purpose. However, many disinfectants are not recommended for disinfecting mucous membranes. Therefore, it is important to understand the efficacy and precautions of each agent before making a choice. This article aims to describe the indications, contraindications, and precautions for the agents frequently used in gastrointestinal surgical field antisepsis and summarize the results of recent studies on the efficacy of these agents. |
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| AbstractList | Povidone iodine, alcohol, and chlorhexidine gluconate are commonly used for skin antisepsis in surgical settings. Recently, a randomized controlled trial confirmed the effectiveness of oranexidine, a new skin antiseptic, for this purpose. However, many disinfectants are not recommended for disinfecting mucous membranes. Therefore, it is important to understand the efficacy and precautions of each agent before making a choice. This article aims to describe the indications, contraindications, and precautions for the agents frequently used in gastrointestinal surgical field antisepsis and summarize the results of recent studies on the efficacy of these agents. |
| Author | SAJI, Masashi HATA, Hiroaki IIO, Megumi |
| Author_xml | – sequence: 1 fullname: IIO, Megumi organization: Department of Nursing, National Hospital Organization, Kyoto Medical Center – sequence: 1 fullname: SAJI, Masashi organization: Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center – sequence: 1 fullname: HATA, Hiroaki organization: Department of Infection Control and Prevention, National Hospital Organization, Kyoto Medical Center |
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| Cites_doi | 10.1097/ALN.0000000000002598 10.1093/oxfordjournals.aje.a120552 10.1016/S1473-3099(16)30398-X 10.1097/SLA.0000000000005244 10.1016/j.jinf.2020.08.022 10.1089/sur.2015.107 10.1016/j.jamcollsurg.2017.01.058 10.1089/sur.2022.141 10.1093/bjsopen/zrac111 10.1001/jamasurg.2017.0904 10.1128/jcm.21.6.991-992.1985 10.1016/S1473-3099(16)30402-9 10.1016/j.jamcollsurg.2016.10.029 10.1097/SLA.0000000000004076 10.1086/501620 10.1016/S1473-3099(17)30448-6 10.1016/j.jhin.2017.04.019 10.1128/AAC.05048-14 10.1177/175045891402401204 10.1016/j.jhin.2022.02.020 10.1002/bjs5.50144 10.1097/JPN.0000000000000334 10.1128/CMR.12.1.147 10.1016/S2666-5247(22)00187-2 10.1016/S1473-3099(20)30225-5 10.1002/bjs5.50177 |
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| References | 9) McDonnell G, Russell AD: Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999; 12: 147-79. 19) Kambara Y, Hiramatsu K, Kato T, Sibata Y, Yoshihara M, Aoba T, et al.: Randomized clinical trial of single skin sterilization with a povidone-iodine applicator versus conventional skin sterilization in abdominal surgery. BJS Open 2019; 3: 282-7. 23) 日本外科感染症学会消化器外科SSI予防のための周術期管理ガイドライン作成委員会: 消化器外科SSI予防のための周術期管理ガイドライン, 診断と治療社, 2018. 13) Casey AL, Badia JM, Higgins A, Korndorffer J, Mantyh C, Mimoz O, et al.: Skin antisepsis: it's not only what you use, it's the way that you use it. J Hosp Infect 2017; 96: 221-2. 16) Carre Y, Moal B, Germain C, Frison E, Dubreuil M, Chansel C, et al.: Randomized study of antiseptic application technique in healthy volunteers before vascular access insertion (TApAS trial). J Infect 2020; 81: 532-9. 18) Lundberg PW, Smith AA, Heaney JB, Wimley WC, Hauch AT, Nichols RL, et al.: Pre-Operative Antisepsis Protocol Compliance and the Effect on Bacterial Load Reduction. Surg Infect (Larchmt) 2016; 17: 32-7. 10) Vanzi V, Pitaro R: Skin Injuries and Chlorhexidine Gluconate-Based Antisepsis in Early Premature Infants: A Case Report and Review of the Literature. J Perinat Neonatal Nurs 2018; 32: 341-50. 4) Haley CE, Marling-Cason M, Smith JW, Luby JP, Mackowiak PA: Bactericidal activity of antiseptics against methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1985; 21: 991-2. 29) Smith SR, Gani J, Carroll R, Lott N, Hampton J, Oldmeadow C, et al.: Antiseptic Skin Agents to Prevent Surgical Site Infection After Incisional Surgery: A Randomized, Three-armed Combined Non-inferiority and Superiority Clinical Trial (NEWSkin Prep Study). Ann Surg 2022; 275: 842-8. 25) Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al.: American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg 2017; 224: 59-74. 26) 国公立大学附属病院感染対策協議会: 手術部位感染: 病院感染対策ガイドライン, じほう, 2020. p. 156-68. 28) Charehbili A, Koek MBG, de Mol van Otterloo JCA, Bronkhorst MWGA, van der Zwaal P, Thomassen B, et al.: Cluster-randomized crossover trial of chlorhexidine-alcohol versus iodine-alcohol for prevention of surgical-site infection (SKINFECT trial). BJS Open 2019; 3: 617-22. 21) Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al.: New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16: e276-87. 31) Hasegawa T, Tashiro S, Mihara T, Kon J, Sakurai K, Tanaka Y, et al.: Efficacy of surgical skin preparation with chlorhexidine in alcohol according to the concentration required to prevent surgical site infection: meta-analysis. BJS Open 2022; 6. 12) Hagi A, Iwata K, Nii T, Nakata H, Tsubotani Y, Inoue Y: Bactericidal Effects and Mechanism of Action of Olanexidine Gluconate, a New Antiseptic. Antimicrob Agents Chemother 2015; 59: 4551-9. 24) Berrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al.: Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017; 152: 784-91. 30) Jalalzadeh H, Groenen H, Buis DR, Dreissen YE, Goosen JH, Ijpma FF, et al.: Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis. Lancet Microbe 2022; 3: e762-71. 5) Iijima S, Kuramochi M: Investigation of irritant skin reaction by 10% povidone-iodine solution after surgery. Dermatology 2002; 204 (Suppl 1): 103-8. 17) Bertasi RAO, Bertasi TGO, Jethwa TE, Pujalte GGA: Peri-Operative Method of Applying Chlorhexidine and Iodine as Skin Preparation Solutions: Does It Matter? A Literature Review. Surg Infect (Larchmt) 2022; 23: 699-704. 20) Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al.: New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16: e288-303. 11) 厚生労働省: 医薬・生活衛生局安全対策課長通知 平成28年5月31日付薬生安発0531第2号「クロルヘキシジングルコン酸塩を含有する外皮用殺菌消毒剤に係る「使用上の注意」の改訂について」: https://www.pmda.go.jp/files/000212231.pdf: 2023年2月28日現在. 3) Hsu YC, Nomura S, Kruse CW: Some bactericidal and virucidal properties of iodine not affecting infectious RNA and DNA. Am J Epidemiol 1965; 82: 317-28. 15) Monstrey SJ, Lepelletier D, Simon A, Touati G, Vogt S, Favalli F: Evaluation of the antiseptic activity of 5% alcoholic povidone-iodine solution using four different modes of application: a randomized open-label study. J Hosp Infect 2022; 123: 67-73. 8) Jones EL, Overbey DM, Chapman BC, Jones TS, Hilton SA, Moore JT, et al.: Operating Room Fires and Surgical Skin Preparation. J Am Coll Surg 2017; 225: 160-5. 1) Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR: Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999; 20: 250-78; quiz 79-80. 2) Obara H, Takeuchi M, Kawakubo H, Shinoda M, Okabayashi K, Hayashi K, et al.: Aqueous olanexidine versus aqueous povidone-iodine for surgical skin antisepsis on the incidence of surgical site infections after clean-contaminated surgery: a multicentre, prospective, blinded-endpoint, randomised controlled trial. Lancet Infect Dis 2020; 20: 1281-9. 14) Silva P: The right skin preparation technique: a literature review. J Perioper Pract 2014; 24: 283-5. 6) Jones TS, Black IH, Robinson TN, Jones EL: Operating Room Fires. Anesthesiology 2019; 130: 492-501. 7) 医療事故情報収集等事業: 3 再発・類似事例の発生状況【3】「電気メスによる薬剤の引火」 (医療安全情報No.34) について: http://www.med-safe.jp/pdf/report_2014_1_R003.pdf: 2023年2月28日現在. 32) Wade RG, Burr NE, McCauley G, Bourke G, Efthimiou O: The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis. Ann Surg 2021; 274: e481-8. 27) Maiwald M, Widmer AF: WHO's recommendation for surgical skin antisepsis is premature. Lancet Infect Dis 2017; 17: 1023-4. 22) National Institute for Health and Care Excellence: Surgical site infections: prevention and treatment NICE guideline [NG125]: 2019https://www.nice.org.uk/guidance/ng125. accessed February 28, 2023. 22 23 24 25 26 27 28 29 (5) 2002; 204 30 31 10 32 11 12 13 14 15 16 17 18 19 1 2 3 4 6 7 8 9 20 21 |
| References_xml | – reference: 9) McDonnell G, Russell AD: Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999; 12: 147-79. – reference: 30) Jalalzadeh H, Groenen H, Buis DR, Dreissen YE, Goosen JH, Ijpma FF, et al.: Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis. Lancet Microbe 2022; 3: e762-71. – reference: 16) Carre Y, Moal B, Germain C, Frison E, Dubreuil M, Chansel C, et al.: Randomized study of antiseptic application technique in healthy volunteers before vascular access insertion (TApAS trial). J Infect 2020; 81: 532-9. – reference: 27) Maiwald M, Widmer AF: WHO's recommendation for surgical skin antisepsis is premature. Lancet Infect Dis 2017; 17: 1023-4. – reference: 1) Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR: Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999; 20: 250-78; quiz 79-80. – reference: 18) Lundberg PW, Smith AA, Heaney JB, Wimley WC, Hauch AT, Nichols RL, et al.: Pre-Operative Antisepsis Protocol Compliance and the Effect on Bacterial Load Reduction. Surg Infect (Larchmt) 2016; 17: 32-7. – reference: 3) Hsu YC, Nomura S, Kruse CW: Some bactericidal and virucidal properties of iodine not affecting infectious RNA and DNA. Am J Epidemiol 1965; 82: 317-28. – reference: 17) Bertasi RAO, Bertasi TGO, Jethwa TE, Pujalte GGA: Peri-Operative Method of Applying Chlorhexidine and Iodine as Skin Preparation Solutions: Does It Matter? A Literature Review. Surg Infect (Larchmt) 2022; 23: 699-704. – reference: 5) Iijima S, Kuramochi M: Investigation of irritant skin reaction by 10% povidone-iodine solution after surgery. Dermatology 2002; 204 (Suppl 1): 103-8. – reference: 6) Jones TS, Black IH, Robinson TN, Jones EL: Operating Room Fires. Anesthesiology 2019; 130: 492-501. – reference: 10) Vanzi V, Pitaro R: Skin Injuries and Chlorhexidine Gluconate-Based Antisepsis in Early Premature Infants: A Case Report and Review of the Literature. J Perinat Neonatal Nurs 2018; 32: 341-50. – reference: 29) Smith SR, Gani J, Carroll R, Lott N, Hampton J, Oldmeadow C, et al.: Antiseptic Skin Agents to Prevent Surgical Site Infection After Incisional Surgery: A Randomized, Three-armed Combined Non-inferiority and Superiority Clinical Trial (NEWSkin Prep Study). Ann Surg 2022; 275: 842-8. – reference: 19) Kambara Y, Hiramatsu K, Kato T, Sibata Y, Yoshihara M, Aoba T, et al.: Randomized clinical trial of single skin sterilization with a povidone-iodine applicator versus conventional skin sterilization in abdominal surgery. BJS Open 2019; 3: 282-7. – reference: 25) Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al.: American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg 2017; 224: 59-74. – reference: 32) Wade RG, Burr NE, McCauley G, Bourke G, Efthimiou O: The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis. Ann Surg 2021; 274: e481-8. – reference: 11) 厚生労働省: 医薬・生活衛生局安全対策課長通知 平成28年5月31日付薬生安発0531第2号「クロルヘキシジングルコン酸塩を含有する外皮用殺菌消毒剤に係る「使用上の注意」の改訂について」: https://www.pmda.go.jp/files/000212231.pdf: 2023年2月28日現在. – reference: 24) Berrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al.: Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017; 152: 784-91. – reference: 7) 医療事故情報収集等事業: 3 再発・類似事例の発生状況【3】「電気メスによる薬剤の引火」 (医療安全情報No.34) について: http://www.med-safe.jp/pdf/report_2014_1_R003.pdf: 2023年2月28日現在. – reference: 13) Casey AL, Badia JM, Higgins A, Korndorffer J, Mantyh C, Mimoz O, et al.: Skin antisepsis: it's not only what you use, it's the way that you use it. J Hosp Infect 2017; 96: 221-2. – reference: 14) Silva P: The right skin preparation technique: a literature review. J Perioper Pract 2014; 24: 283-5. – reference: 8) Jones EL, Overbey DM, Chapman BC, Jones TS, Hilton SA, Moore JT, et al.: Operating Room Fires and Surgical Skin Preparation. J Am Coll Surg 2017; 225: 160-5. – reference: 23) 日本外科感染症学会消化器外科SSI予防のための周術期管理ガイドライン作成委員会: 消化器外科SSI予防のための周術期管理ガイドライン, 診断と治療社, 2018. – reference: 31) Hasegawa T, Tashiro S, Mihara T, Kon J, Sakurai K, Tanaka Y, et al.: Efficacy of surgical skin preparation with chlorhexidine in alcohol according to the concentration required to prevent surgical site infection: meta-analysis. BJS Open 2022; 6. – reference: 20) Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al.: New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16: e288-303. – reference: 28) Charehbili A, Koek MBG, de Mol van Otterloo JCA, Bronkhorst MWGA, van der Zwaal P, Thomassen B, et al.: Cluster-randomized crossover trial of chlorhexidine-alcohol versus iodine-alcohol for prevention of surgical-site infection (SKINFECT trial). BJS Open 2019; 3: 617-22. – reference: 2) Obara H, Takeuchi M, Kawakubo H, Shinoda M, Okabayashi K, Hayashi K, et al.: Aqueous olanexidine versus aqueous povidone-iodine for surgical skin antisepsis on the incidence of surgical site infections after clean-contaminated surgery: a multicentre, prospective, blinded-endpoint, randomised controlled trial. Lancet Infect Dis 2020; 20: 1281-9. – reference: 15) Monstrey SJ, Lepelletier D, Simon A, Touati G, Vogt S, Favalli F: Evaluation of the antiseptic activity of 5% alcoholic povidone-iodine solution using four different modes of application: a randomized open-label study. J Hosp Infect 2022; 123: 67-73. – reference: 4) Haley CE, Marling-Cason M, Smith JW, Luby JP, Mackowiak PA: Bactericidal activity of antiseptics against methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1985; 21: 991-2. – reference: 21) Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al.: New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16: e276-87. – reference: 26) 国公立大学附属病院感染対策協議会: 手術部位感染: 病院感染対策ガイドライン, じほう, 2020. p. 156-68. – reference: 22) National Institute for Health and Care Excellence: Surgical site infections: prevention and treatment NICE guideline [NG125]: 2019https://www.nice.org.uk/guidance/ng125. accessed February 28, 2023. – reference: 12) Hagi A, Iwata K, Nii T, Nakata H, Tsubotani Y, Inoue Y: Bactericidal Effects and Mechanism of Action of Olanexidine Gluconate, a New Antiseptic. Antimicrob Agents Chemother 2015; 59: 4551-9. – ident: 6 doi: 10.1097/ALN.0000000000002598 – ident: 3 doi: 10.1093/oxfordjournals.aje.a120552 – ident: 21 doi: 10.1016/S1473-3099(16)30398-X – ident: 29 doi: 10.1097/SLA.0000000000005244 – ident: 16 doi: 10.1016/j.jinf.2020.08.022 – ident: 18 doi: 10.1089/sur.2015.107 – ident: 8 doi: 10.1016/j.jamcollsurg.2017.01.058 – ident: 17 doi: 10.1089/sur.2022.141 – ident: 31 doi: 10.1093/bjsopen/zrac111 – ident: 24 doi: 10.1001/jamasurg.2017.0904 – ident: 4 doi: 10.1128/jcm.21.6.991-992.1985 – ident: 7 – ident: 20 doi: 10.1016/S1473-3099(16)30402-9 – ident: 26 – ident: 22 – ident: 25 doi: 10.1016/j.jamcollsurg.2016.10.029 – ident: 32 doi: 10.1097/SLA.0000000000004076 – ident: 1 doi: 10.1086/501620 – ident: 27 doi: 10.1016/S1473-3099(17)30448-6 – ident: 11 – ident: 13 doi: 10.1016/j.jhin.2017.04.019 – ident: 12 doi: 10.1128/AAC.05048-14 – ident: 14 doi: 10.1177/175045891402401204 – ident: 15 doi: 10.1016/j.jhin.2022.02.020 – ident: 19 doi: 10.1002/bjs5.50144 – ident: 10 doi: 10.1097/JPN.0000000000000334 – ident: 9 doi: 10.1128/CMR.12.1.147 – volume: 204 start-page: 103 issn: 1018-8665 issue: Suppl 1 year: 2002 ident: 5 publication-title: Dermatology – ident: 30 doi: 10.1016/S2666-5247(22)00187-2 – ident: 2 doi: 10.1016/S1473-3099(20)30225-5 – ident: 28 doi: 10.1002/bjs5.50177 – ident: 23 |
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| Title | Safe and Effective Skin Antiseptics in Gastrointestinal Surgery |
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