title: A randomized trial of a skin sealant to reduce the risk of incision contamination in cardiac surgery.
abstract: BACKGROUND
  Immobilizing skin microbes is a rational approach to reducing contamination of surgical sites by endogenous microorganisms.
  
  
  METHODS
  This randomized, controlled, parallel-group, multicenter, open-label clinical trial (ClinicalTrials.gov NCT00467857) enrolled 300 adults scheduled for elective coronary artery bypass graft surgery. Patients received iodine-based skin preparations followed by a cyanoacrylate-based skin sealant or skin preparations alone. Microbiological samples collected from sternal and graft incision sites immediately before any skin preparation, at the wound border after skin incision, and at the incision after fascial closure were evaluated quantitatively.
  
  
  RESULTS
  In evaluable patients, mean microbial counts in collected samples increased at the sternal site after fascial closure compared with after skin incision by 0.37 log10 colony-forming units (CFU)/mL in the skin sealant group (n=120) and by 0.57 log10 CFU/mL in the control group (n=132) (p=0.047, Wilcoxon rank sum test). At the graft site, mean microbial counts increased by 0.09 (n=119) and 0.27 (n=127) log10 CFU/mL, respectively (p=0.037). There was a 35.3% relative risk reduction in surgical site infection (SSI) occurring in the skin sealant group (9 of 146 patients, 6.2%) versus the control group (14 of 147 patients, 9.5%). In obese patients (body mass index [BMI]>30.0 to ≤37.0 kg/m2), the relative risk reduction for SSI associated with skin sealant was 83.3%.
  
  
  CONCLUSIONS
  Pretreatment with skin sealant protects against contamination of the surgical incision by migration of skin microbes. Further data are needed to confirm the impact of this technology on SSI rates in clinical practice.
authors.affiliation: Hospital Dr. Hernan Henriquez Aravena, Temuco, Chile. abdelardosilva@gmail.com
authors.forename: Abelardo Silva
authors.initials: AS
authors.lastname: von Eckardstein
authors.forename: Chong H
authors.initials: CH
authors.lastname: Lim
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Dohmen
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Pêgo-Fernandes
authors.forename: William A
authors.initials: WA
authors.lastname: Cooper
authors.forename: Susan G
authors.initials: SG
authors.lastname: Oslund
authors.forename: E Lynne
authors.initials: EL
authors.lastname: Kelley
mesh_terms: D000368:Aged; D058491:Bacterial Load; D003114:Colony-Forming Units Assay; D001026:Coronary Artery Bypass; D003487:Cyanoacrylates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000382:microbiology; D056346:Sternotomy; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D014014:Tissue Adhesives / Q000008:administration & dosage*
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives