Iodine Impregnated Incision Drapes and Bacterial Recolonization in Simulated Total Knee Arthroplasty. A Controlled Randomized Experimental Trial.

Background

Surgical site infection (SSI) is a serious complication to orthopaedic surgery, resulting in re-operation and prolonged recovery (1, 2)

To prevent SSI, prophylactic methods have been introduced as part of procedure in many types of surgery. Prophylactic strategies such as preoperative disinfection using chlorhexidine or iodine solutions with alcohol have been shown to decrease the number of skin bacteria prior to surgical incision or intravenous catheter insertion. (3-7). Creating a completely aseptic environment for the duration of surgery is however impossible, due to the inability of preoperative disinfection to completely sterilize the skin, combined with re-colonization of the patients endogenous flora from hair follicles, sebaceous glands and sweat glands.(6) (8, 9)

The use of self-adhesive plastic drapes was introduced to prevent contamination of the surgical site due to re-colonizing skin flora, by blocking the translocation of bacteria from the skin adjacent to the surgical site into the surgical wound. Self-adhesive plastic incision drapes are in this way designed to work as a barrier, containing skin flora during surgery.

These types of drapes have however been found to be inferior in preventing bacterial SSI, compared to newer drape types that incorporates an antiseptic iodine-complex into the drape adhesive, facing the skin (10, 11) This outcome might be explained by a drape-induced "greenhouse effect" supported by evidence of increased bacterial colonization-rate with the intraoperative use of non-iodine self-adhesive plastic drapes (12, 13). This effect may be a result of relative occlusion of the skin leading to an increase in skin hydration.(14) This increase in bacterial growth has never been demonstrated in iodine impregnated self-adhesive incision drapes (IIAD) and has been contradicted in studies reporting a reduction in re-colonization rate of skin bacteria on the abdomen when IIAD was compared to no draping and non-iodine drapes while other authors reported decrease in surgical wound contamination when IIAD was used preoperatively in abdominal surgery (3, 15)