title: Significant reduction in incidence of wound contamination by skin flora through use of microbial sealant.
abstract: OBJECTIVE
  Application of skin sealant prior to incision reduces microbial contamination of the wound.
  
  
  METHODS
  Prospective, randomized, multicenter clinical trial.
  
  
  METHODS
  Six teaching hospitals.
  
  
  METHODS
  A total of 177 adult patients undergoing elective open inguinal hernia repair were randomized to either standard skin preparation with 10% povidone-iodine or skin preparation followed by cyanoacrylate-based liquid microbial sealant.
  
  
  METHODS
  Wound contamination was assessed during surgery by microbial sampling inside the wound at initiation of skin incision and prior to skin closure.
  
  
  METHODS
  The primary outcome measures were the safety and effectiveness of cyanoacrylate-based microbial sealant to reduce bacterial contamination during surgery. The secondary outcome measure was reduction of postoperative surgical site infections using microbial sealant.
  
  
  RESULTS
  Demographics were similar. Patients treated with sealant were more likely to have no bacterial cells found in the wound than control participants (47% vs 31%; P = .04). Three patients developed surgical site infections; all were in the control group (P = .25). Independent factors that reduced wound contamination were use of microbial sealant (odds ratio, 0.45; confidence interval, 0.23-0.88; P = .02) and perioperative antibiotics (odds ratio, 0.24; confidence interval, 0.10-0.58; P = .001).
  
  
  CONCLUSIONS
  Cyanoacrylate-based microbial sealant may be an important tool to reduce wound contamination and potentially prevent surgical site infections.
authors.affiliation: Department of Surgery at Cedars-Sinai Medical Center, Los Angeles, California, USA. shirin.towfigh@cshs.org
authors.forename: Shirin
authors.initials: S
authors.lastname: Towfigh
authors.forename: William G
authors.initials: WG
authors.lastname: Cheadle
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Lowry
authors.forename: Mark A
authors.initials: MA
authors.lastname: Malangoni
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D003487:Cyanoacrylates / Q000627:therapeutic use*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D018579:Patient Selection; D011206:Povidone-Iodine / Q000627:therapeutic use; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D003487:Cyanoacrylates; D011206:Povidone-Iodine