title: A Comparison of Two Sterile Solution Application Methods During Surgical Preparation of the Hand.
abstract: OBJECTIVE
  The purpose of this study was to determine the extent of skin coverage during surgical preparation of the hand when preparation is done by 2 different methods. We hypothesized that hand preparation with commercially available prep-stick applicators (PS) would lead to more unprepared areas (UPAs) of skin compared with immersed 4 × 4 inch sterile gauze sponges (GS) used as controls.
  
  
  METHODS
  Sixty upper extremities of 30 healthy volunteers were used for this study. The hands were prepped by 2 fellowship trained orthopedic hand surgeons as 30 matched pairs. The experimental group was prepped using a commercially available PS (ChloraPrep, Carefusion, San Diego, CA), whereas the control group was prepared with GS immersed in the prep solution and applied manually using sterile gloves. The number and location of UPAs in the hands and wrists of volunteers after preparation were recorded. In addition, the sum of UPAs relative to the total surface area of the skin was quantified with image analysis software.
  
  
  RESULTS
  There were a total of 77 UPAs when prepping the volunteers with PS, compared with 14 in the control hands. This difference was statistically significant. Similarly, the average percentage area of UPAs relative to the total skin surface was 0.76% (range, 0.006% to 2.15%) when using PS compared with 0.15% (range, 0.005% to 0.56%) in the controls. This difference was statistically significant.
  
  
  CONCLUSIONS
  We identified a larger numbers of UPAs with commercially available applicator sticks compared with a control using sterile GS.
  
  
  CONCLUSIONS
  The clinical implications of these findings are unknown.
authors.affiliation: Department of Orthopaedic Surgery, Division of Hand Surgery, Rothman Institute, Jefferson Medical College, Philadelphia, PA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Seigerman
authors.affiliation: Department of Orthopaedic Surgery, Division of Hand Surgery, Rothman Institute, Jefferson Medical College, Philadelphia, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rivlin
authors.affiliation: College of Biomedical Engineering, Drexel University, Philadelphia, PA.
authors.forename: Justin
authors.initials: J
authors.lastname: Bianchini
authors.affiliation: Department of Orthopaedic Surgery, Division of Hand Surgery, Rothman Institute, Jefferson Medical College, Philadelphia, PA.
authors.forename: Frederick E
authors.initials: FE
authors.lastname: Liss
authors.affiliation: Department of Orthopaedic Surgery, Division of Hand Surgery, Rothman Institute, Jefferson Medical College, Philadelphia, PA. Electronic address: Pedro.Beredjiklian@Rothmaninstitute.com.
authors.forename: Pedro K
authors.initials: PK
authors.lastname: Beredjiklian
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006225:Hand / Q000601:surgery*; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D012680:Sensitivity and Specificity; D012867:Skin / Q000187:drug effects / Q000382:microbiology; D013530:Surgical Wound Infection / Q000517:prevention & control
chemical_list: D000891:Anti-Infective Agents, Local
keywords: Prep-stick applicators; skin coverage; surgical preparation; unprepared areas