Surgical Site Infection
Conditions
Keywords
orthopedic surgery, nasal povidone-iodine
Brief summary
The purpose of this study is to see whether applying povidone iodine (PVI) to the noses of patients undergoing lower extremity (leg, ankle, or foot) orthopedic fixation procedures of high-energy lower extremity fractures (HELEF) will decrease the patients' risk of surgical site infections (SSI), particularly those caused by Staphylococcus aureus.
Detailed description
These patients are at high risk of SSI but given the rapidity with which they need their operations, interventions that take time are difficult or impossible to use in this patient population. This study will involve identifying patients with HELEF and applying PVI to their nares within 60 minutes before their surgical incisions are made and again approximately 12 hours after the first dose. The investigators will abstract information from the patients' medical records about their demographics, underlying illnesses, injury severity, the surgical procedures, and SSI for the 6 months following their operations and the investigators will see them during their routinely scheduled visit at about 6 months to ask them whether they were treated for SSI by providers outside of our system. For patients who do not return for follow up, the investigators will try to contact them to determine if they had signs or symptoms of SSI or were treated for SSI outside of our system.
Interventions
Intranasal povidone-iodine will be applied to the lower anterior nares (i.e. nostril) of patients undergoing HELEF orthopedic repair.
Sponsors
Loreen Herwaldt
Indiana University
University of Utah
Washington University School of Medicine
University of Texas
Emory University
PDI Healthcare
Centers for Disease Control and Prevention
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years of age. * Is undergoing one or more procedures to address the included fractures listed below for one or more (at least one) HELEF at high-risk for SSI: * Open tibia fractures * Open femur fractures * Open or closed tibial plateau fractures * Open or closed tibial pilon fractures * Open or closed calcaneus fractures * Open or closed talus fractures * Open or closed foot fractures of any bone EXCEPT the toes * Open fibula fractures * Open rotational ankle fractures (malleoli) * Open or closed leg fractures associated with compartment syndrome * Examples of included procedures: * Excisional debridement of open fracture, femur and/or tibia * Intramedullary nail, tibia (open injury) * Intramedullary nail, femur (open injury) * Open reduction Pilon/Plafond fracture * Open reduction tibial plateau fracture * Open reduction calcaneal fracture * Open reduction Lisfranc/metatarsal associated with crush injury * Open reduction talus * External fixation, lower extremity tibia or femur associated with open fracture or compartment syndrome * Fasciotomy, lower extremity for compartment syndrome related to femur, tibia, or foot fracture * Lower extremity amputation related to HELEF
Exclusion criteria
* Documented or verbalized sensitivity or allergy to iodine or iodine-based contrast. * Known pregnancy in women. * Active bacterial infection at the HELEF site. * Incarcerated persons. * Persons who cannot follow up at the participating site (e.g., people who are homeless at the time of the injury or people with intellectual challenges who lack the social support for follow up visits). * Patients with facial fractures or other conditions that preclude nasal swabbing. * Patients who do not speak English or Spanish.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Complex (deep incisional or organ space) Staphylococcus aureus surgical site infection (SSI) | within 180 days of the initial surgical procedure for HELEF repair | Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) definitions for SSI found in the "Surgical Site Infection Event (SSI)" guide at https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of all Staphylococcus aureus SSI | within 180 days of the initial surgical procedure for HELEF repair | Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) definitions for SSI found in the "Surgical Site Infection Event (SSI)" guide at https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf |
| Incidence of all Complex SSI | within 180 days of the initial surgical procedure for HELEF repair | Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) definitions for SSI found in the "Surgical Site Infection Event (SSI)" guide at https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf |
| Incidence of all gram-negative Complex SSI | within 180 days of the initial surgical procedure for HELEF repair | Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) definitions for SSI found in the "Surgical Site Infection Event (SSI)" guide at https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf |
| Incidence of cellulitis involving the surgical site | within 180 days of the initial surgical procedure for HELEF repair | Cellulitis is a common bacterial skin infection that causes redness, swelling, and pain in the infected area of the skin surrounding the surgical site of the HELEF repair. |
| Clavien-Dindo assessment of postoperative complications scores | within 180 days of the initial surgical procedure for HELEF repair | The Clavien-Dindo assessment grades postoperative surgical complications from 1 to 5, with 5 being the worst outcome. Postoperative courses with no evidence of complications have no grade (a "0" for the purposes of this study). Clavien-Dindo assessment definitions found at: https://www.assessurgery.com/clavien-dindo-classification/ |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORLoreen Herwaldt, MD
University of Iowa
Outcome results
None listed