title: Preoperative skin and nail preparation of the foot: comparison of the efficacy of 4 different methods in reducing bacterial load.
abstract: BACKGROUND
  Orthopedic surgical procedures involving the foot and ankle are associated with high rates of infection. The optimal method of preparing the skin and nails for foot and ankle surgery remains unknown.
  
  
  OBJECTIVE
  This study was conducted to compare the efficacy of 4 different methods of skin and nail preparation of the foot using various antiseptic solutions.
  
  
  METHODS
  In this prospective, randomized study, 4 methods of skin and nail preparation were compared in terms of their efficacy in eliminating bacteria from the hallux nailfold and first web space of the normal foot in 28 healthy adult volunteers. Efficacy was determined by evaluating the difference in the total bacterial load before and after skin preparation. The foot-preparation solutions evaluated were 4% chlorhexidine gluconate, 70% isopropyl alcohol, and 7.5% to 10% povidone-iodine.
  
  
  RESULTS
  The addition of alcohol to povidone-iodine was found to increase the efficacy of the preparation method. The nailfold remained contaminated after any of the preoperative skin- and nail-preparation methods studied.
  
  
  CONCLUSIONS
  This study did not measure clinically relevant infections, and the results may not correlate with decreased rates of infection after surgery.
  
  
  CONCLUSIONS
  Incorporation of alcohol and povidone-iodine into the preoperative skin- and nail-preparation process may help reduce the bacterial load. Every effort should be made to lower the risk of contamination from the nail.
authors: Escuela Universitaria de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain. ribebeva@enf.ucm.es
authors: Ricardo
authors: R
authors: Becerro de Bengoa Vallejo
authors: Marta Elena
authors: ME
authors: Losa Iglesias
authors: Luis
authors: L
authors: Alou Cervera
authors: David
authors: D
authors: Sevillano Fernández
authors: José
authors: J
authors: Prieto Prieto
mesh_terms: D019840:2-Propanol / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification*; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D015169:Colony Count, Microbial; D005260:Female; D005528:Foot / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000382:microbiology*; D019637:Orthopedic Procedures; D011206:Povidone-Iodine / Q000627:therapeutic use; D011300:Preoperative Care; D012867:Skin / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine