title: Efficacy of surgical preparation solutions in lumbar spine surgery.
abstract: BACKGROUND
  Postoperative spinal wound infections are relatively common and are often associated with increased morbidity and poor long-term patient outcomes. The purposes of this study were to identify the common bacterial flora on the skin overlying the lumbar spine and evaluate the efficacy of readily available skin-preparation solutions in the elimination of bacterial pathogens from the surgical site following skin preparation.
  
  
  METHODS
  A prospective randomized study was undertaken to evaluate 100 consecutive patients undergoing elective lumbar spine surgery. At the time of surgery, the patients were randomized to be treated with one of two widely used, and Food and Drug Administration (FDA)-approved, surgical skin-preparation solutions: ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol) or DuraPrep (0.7% available iodine and 74% isopropyl alcohol). Specimens for aerobic and anaerobic cultures were obtained prior to skin preparation (pre-preparation), after skin preparation (post-preparation), and after wound closure (post-closure). A validated neutralization solution was used for each culture to ensure that the antimicrobial activity was stopped immediately after the sample was taken. Positive cultures and specific bacterial pathogens were recorded.
  
  
  RESULTS
  Coagulase-negative Staphylococcus, Propionibacterium acnes, and Corynebacterium were the most commonly isolated organisms prior to skin preparation. The overall rate of positive cultures prior to skin preparation was 82%. The overall rate of positive cultures after skin preparation was 0% (zero of fifty) in the ChloraPrep group and 6% (three of fifty) in the DuraPrep group (p = 0.24, 95% confidence interval [CI] = 0.006 to 0.085). There was an increase in positive cultures after wound closure, but there was no difference between the ChloraPrep group (34%, seventeen of fifty) and the DuraPrep group (32%, sixteen of fifty) (p = 0.22, 95% CI = 0.284 to 0.483). Body mass index (BMI), duration of surgery, and estimated blood loss did not a show significant association with post-closure positive culture results.
  
  
  CONCLUSIONS
  ChloraPrep and DuraPrep are equally effective skin-preparation solutions for eradication of common bacterial pathogens on the skin overlying the lumbar spine.
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Savage
authors.forename: Brian M
authors.initials: BM
authors.lastname: Weatherford
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Sugrue
authors.forename: Mark T
authors.initials: MT
authors.lastname: Nolden
authors.forename: John C
authors.initials: JC
authors.lastname: Liu
authors.forename: John K
authors.initials: JK
authors.lastname: Song
authors.forename: Michael H
authors.initials: MH
authors.lastname: Haak
mesh_terms: D019840:2-Propanol / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000494:pharmacology* / Q000627:therapeutic use; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D006801:Humans; D007455:Iodine / Q000494:pharmacology*; D008159:Lumbar Vertebrae / Q000601:surgery; D008875:Middle Aged; D019637:Orthopedic Procedures; D011300:Preoperative Care; D011446:Prospective Studies; D012867:Skin / Q000187:drug effects / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; C515331:DuraPrep; D007455:Iodine; C010882:chlorhexidine gluconate; D019840:2-Propanol; D002710:Chlorhexidine