Updated Recommendations for Control of Surgical Site Infections

J. Wesley Alexander, MD, ScD; Joseph S. Solomkin, MD; Michael J. Edwards, MD

Disclosures

Annals of Surgery. 2011;253(6):1082-1093. 

In This Article

Incise Drapes

The use of plastic adhesive incise drapes to prevent contamination of the wound from skin organisms has been used for at least 50 years. Reports of controlled studies have had mixed results, some showing some benefit (6, SDC-46-49) whereas others report no benefit (SDC50-54). A major part of these discrepancies is related to differences in the composition of the drapes themselves. The drapes available after 1985 are more pliable, have increased water vapor transmission and a more aggressive adhesive, which has an iodophor incorporated. Use of the older drapes without the iodophor has been associated with an increase in separation of the drape from the skin edges at the incision. One study showed that if lifting at the edge of the skin occurs, the infection rate was 6-fold greater when compared to operations in which the incise drape did not lift.[6] The studies before use of the new drape, in general, showed no benefit or an increase in infections when compared to no drape at all. Even when there was no difference in postoperative wound infection rates, the numbers of viable organisms on the surface of the skin at the completion of the operation was decreased by the use of the iodophor-containing drapes. Adhesiveness to the skin has been shown to improve with an initial alcohol or tincture of iodine solution prep of the skin (6, SDC-55). Conversally, use of a detergent increases the rate of lift. Adhesion to the skin has been most effective by preparation of the skin with alcohol followed by application of an alcohol-based iodophor (iodine povacrylex) and letting this dry thoroughly before application of the incise drape (SDC-55). Pressure should be applied to activate the pressure-sensitive glue. This type of drape application is also cost-effective when compared to skin preparation with povidone iodine alone (6, SDC-55).

A variant of this concept, application of a cyanoacrylate based "microbial sealant" to the operative site to trap microbes on the skin, has recently been introduced (SDC-56). This product has been shown to reduce wound colonization (SDC-57), but its ability to reduce infection needs further study before general recommendation.

Interpretation

The use of an adhesive antimicrobial incise drape may or may not decrease the incidence of wound infection, depending upon composition of the drape, preparation of the skin and adherence to the wound edges. Technique is important. With proper application of the incise drape to prevent lifting from the skin edge, contamination of the wound with skin organisms is not possible. A cyanoacrylate based skin sealant has been marketed recently, but requires further investigation.

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