Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites.
BACKGROUND
Antiseptic preoperative skin site preparation is used to prepare the operative site before making a surgical incision. The goal of this preparation is a reduction in postoperative wound infection. The most straightforward technique necessary to achieve this goal remains controversial.


METHODS
A prospective randomized trial was designed to prove equivalency for two commonly used techniques of surgical skin site preparation. Two hundred thirty-four patients undergoing nonlaparoscopic abdominal operations were consented for the trial. Exclusion criteria included presence of active infection at the time of operation, neutropenia, history of skin reaction to iodine, or anticipated insertion of prosthetic material at the time of operation. Patients were randomized to receive either a vigorous 5-minute scrub with povidone-iodine soap, followed by absorption with a sterile towel, and a paint with aqueous povidone-iodine or surgical site preparation with a povidone-iodine paint only. The primary end point of the study was wound infection rate at 30 days, defined as presence of clinical signs of infection requiring therapeutic intervention.


RESULTS
Patients randomized to the scrub-and-paint arm (n = 115) and the paint-only arm (n = 119) matched at baseline with respect to age, comorbidity, wound classification, mean operative time, placement of drains, prophylactic antibiotic use, and surgical procedure (all p > 0.09). Wound infection occurred in 12 (10%) scrub-and-paint patients, and 12 (10%) paint-only patients. Based on our predefined equivalency parameters, we conclude equivalence of infection rates between the two preparations.


CONCLUSIONS
Preoperative preparation of the abdomen with a scrub with povidone-iodine soap followed by a paint with aqueous povidone-iodine can be abandoned in favor of a paint with aqueous povidone-iodine alone. This change will result in reductions in operative times and costs.
Ellenhorn
Joshua D I
JD
Division of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
Smith
David D
DD
Schwarz
Roderich E
RE
Kawachi
Mark H
MH
Wilson
Timothy G
TG
McGonigle
Kathryn F
KF
Wagman
Lawrence D
LD
Paz
I Benjamin
IB
D034861:Abdominal Wall; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D004203:Disinfection / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011300:Preoperative Care / Q000379:methods; D012867:Skin; D017592:Skin Care / Q000379:methods; D012915:Soaps / Q000627:therapeutic use; D012996:Solutions / Q000627:therapeutic use; D013514:Surgical Procedures, Operative; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000891:Anti-Infective Agents, Local; D012915:Soaps; D012996:Solutions; D011206:Povidone-Iodine