Surgical Site Infections
Conditions
Keywords
chlorhexidine in alcoholic solution, PVP iodine in alcoholic solution, preoperative skin antisepsis
Brief summary
Prospective cluster-randomized multicenter cross-over trial to prove non-inferiority of PI compared to CHX in preoperative skin antisepsis
Detailed description
Surgical site infections (SSIs) are the most common nosocomial infections in surgical patients causing significant increases in morbidity, mortality, and health care costs. As they are usually caused by components of the normal skin flora, disinfection of the surgical site with an antiseptic skin preparation is standard practice prior to any surgical intervention. The most commonly used disinfectants are either chlorhexidine in alcoholic solution (CHX) or PVP iodine in alcoholic solution (PI) This prospective cluster-randomized multicenter cross-over trial is to prove non-inferiority of PI compared to CHX in preoperative skin antisepsis in abdominal and cardiothoracic surgery in regard of SSIs.
Interventions
DRUGCHX disinfection
CHX (Softasept® Chlorhexidine solution 2% coloured, from B. Braun Medical AG) is applied three times on the patient's skin with the use of swabs. The cumulative residence time is a minimum of 3 minutes. The application is performed according to standard procedures of the participating centers and according to manufacturer's recommendations
DRUGPI Disinfection
PI (Braunoderm® from B.Braun or Betaseptic® from Mundipharma) is applied prior to surgery on the patient's skin with the use of swabs. The product is applied three times. The cumulative residence time is a minimum of 3 minutes. The application is performed according to standard procedures of the participating centers and according to manufacturer's recommendations
Sponsors
Swiss National Science Foundation
University Hospital, Basel, Switzerland
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Outcomes Assessor)
Intervention model description
The intervention will be conducted as an open-label cluster-randomized cross-over multicenter trial with an allocation ratio of 1:1. The departments of surgery of the 3 study sites will be randomized center-wise in clusters by month to use CHX or PI. The products will be switched over according to the computer-generated randomization list.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
\- undergoing cardiac or certain types of abdominal surgery (colorectal surgery, cholecystectomy, herniotomy, appendectomy and bariatric surgery) which are routinely followed up by the study Centers during the study period
Exclusion criteria
* contraindication to the use of either one of the compounds ( CHX: intolerance to any of the compounds of the preparation, application on cornea, wounds or mucosal Membrane. PI: hyperthyroid disease, intolerance to any of the compounds, iodine allergy, 2 weeks prior to radio- iodine treatment, Dermatitis herpetiformis Duhring, application on cornea, wounds or mucosal membranes) * Emergency surgical Intervention * Patients refusing General consent for use of personal data
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Surgical site infections (SSIs) | occurrence of surgical site infections is evaluated at three time points: at time of dismissal from the hospital (approx. 1 week after surgical intervention); 30 days after abdominal and cardiac surgery; 1 year for cardiac surgery | Comparison of SSI rates between the two groups using standard chi-square test. Presence of SSIs for abdominal and cardiac surgeries as defined by Swiss society of hospital epidemiologists (Swissnoso) according to National Healthcare Safety Network (NHSN) criteria. Analysis will be performed using the final SSI rate (30 days for abdominal, 30 days/1 year for cardiac surgery) and according to the different types of infections. Infection ratio will be calculated as crude ratio as well as adapted to the National Nosocomial Infections Surveillance System (NNIS) score. The method of aggregation for the combined SSI rate for both types of surgery together will be a weighted average based on the proportion of SSIs from each surgery type. The measure includes no scale. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Body Mass Index (BMI) | day of surgery | Subgroup analysis stratified by patient factors (i.e. BMI). Weight and height will be combined to report BMI in kg/m\^2). |
| Change in hemoglobin (g/l) | day of surgery | Subgroup analysis stratified by laboratory parameters: hemoglobin (g/l) |
| Mortality | in-hospital (approx. 1 week from surgical intervention) and 30 day for abdominal surgery; in-hospital (approx. 1 week from surgical intervention), 30 day and 365 day for cardiac surgery | death rate |
| Timing of antimicrobial prophylaxis | day of surgery | Timing of antimicrobial prophylaxis (antibiotic, dose,time of application) |
| Duration of surgery | time from start to stop of surgical intervention | Duration of surgery |
| Type of SSI: superficial, deep, organ-space | three time points: at time of dismissal from the hospital (approx. 1 week after surgical intervention); 30 days after abdominal and cardiac surgery; 1 year for cardiac surgery | Type of SSI: superficial, deep, organ-space; DEFINITIONS OF SSI: For surveillance classification purposes, SSIs are divided into incisional SSIs and organ/space SSIs. Incisional SSIs are further classified into those involving only the skin and subcutaneous tissue (called superficial incisional SSIs) and those involving deep soft tissues of the incision (called deep incisional SSIs (e.g., fascial and muscle layers)). Organ/space SSIs involve any part of the anatomy (e.g., organs or spaces), other than the incision, opened or manipulated during the operative procedure. |
| American Society of Anesthesiologists (ASA) -score | day of surgery | ASA physical status classification system is a system for assessing the fitness of patients before surgery. These are: 1. Healthy person. 2. Mild systemic disease. 3. Severe systemic disease. 4. Severe systemic disease that is a constant threat to life. 5. A moribund person who is not expected to survive without the operation. 6. A declared brain-dead person whose organs are being removed for donor purposes. |
| Change in creatinine (ymol/l) | in- hospital stay (approx. 1 week from surgical intervention) | Subgroup analysis stratified by laboratory parameters: creatinine (ymol/l) |
| Change in leukocytes (x10^9/l) | in- hospital stay (approx. 1 week from surgical intervention) | Subgroup analysis stratified by laboratory parameters: leukocytes (x10\^9/l) |
| Change in concentration for C reactive Protein (CRP) (mg/l) | in- hospital stay (approx. 1 week from surgical intervention) | Subgroup analysis stratified by laboratory parameters: CRP (mg/l) |
| National Nosocomial Infections Surveillance System (NNIS) index | in- hospital stay (approx. 1 week from surgical intervention) | NNIS index takes into account 3 risk factors, and each is awarded 1 point: contaminated or dirty-infected surgical wound, American Society of Anesthesiology (ASA) score greater than 2 and surgery duration longer than T (where T is defined as the 75th percentile of the average time for a surgical procedure). |
| Wound contamination -class according to Centers for Disease Control and Prevention(CDC) | three time points: at time of dismissal from the hospital (approx. 1 week after surgical intervention); 30 days after abdominal and cardiac surgery; 1 year for cardiac surgery | Wound contamination -class according to Centers for Disease Control and Prevention(CDC) |
Countries
Switzerland
Outcome results
None listed