title: Effect of antiseptic irrigation on infection rates of traumatic soft tissue wounds: a longitudinal cohort study.
abstract: OBJECTIVE
  Acute traumatic wounds are contaminated with bacteria and therefore an infection risk. Antiseptic wound irrigation before surgical intervention is routinely performed for contaminated wounds. However, a broad variety of different irrigation solutions are in use. The aim of this retrospective, non-randomised, controlled longitudinal cohort study was to assess the preventive effect of four different irrigation solutions before surgical treatment, on wound infection in traumatic soft tissue wounds.
  
  
  METHODS
  Over a period of three decades, the prophylactic application of wound irrigation was studied in patients with contaminated traumatic wounds requiring surgical treatment, with or without primary wound closure. The main outcome measure was development of wound infection. From 1974-1983, either 0.04 % polihexanide (PHMB), 1 % povidone-iodine (PVP-I), 4 % hydrogen peroxide, or undiluted Ringer's solution were concurrently in use. From 1984-1996, only 0.04 % PHMB or 1 % PVP-I were applied. From 1997, 0.04 % PHMB was used until the end of the study period in 2005.
  
  
  RESULTS
  The combined rate for superficial and deep wound infection was 1.7 % in the 0.04 % PHMB group (n=3264), 4.8 % in the 1 % PVP-I group (n=2552), 5.9 % in the Ringer's group (n=645), and 11.7 % in the 4 % hydrogen peroxide group (n=643). Compared with all other treatment arms, PHMB showed the highest efficacy in preventing infection in traumatic soft tissue wounds (p<0.001). However, compared with PVP-I, the difference was only significant for superficial infections.
  
  
  CONCLUSIONS
  The large patient numbers in this study demonstrated a robust superiority of 0.04 % PHMB to prevent infection in traumatic soft tissue wounds. These retrospective results may further provide important information as the basis for power calculations for the urgently needed prospective clinical trials in the evolving field of wound antisepsis.
authors.affiliation: Department for Surgery, Regional Hospital Belp, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Roth
authors.affiliation: Department for Surgery, Regional Hospital Belp, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Neuenschwander
authors.affiliation: Dr. Brill + Partner GmbH, Institute for Hygiene and Mikrobiologie, Hamburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Brill
authors.affiliation: Timaru Hospital, South Canterbury, DHB, New Zealand.
authors.forename: F
authors.initials: F
authors.lastname: Wurmitzer
authors.affiliation: University Medicine Greifswald, Institute of Hygiene and Environmental Medicine, Greifswald, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Wegner
authors.affiliation: Institute of Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, UK.
authors.forename: O
authors.initials: O
authors.lastname: Assadian
authors.affiliation: University Medicine Greifswald, Institute of Hygiene and Environmental Medicine, Greifswald, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kramer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D015331:Cohort Studies; D006801:Humans; D008137:Longitudinal Studies; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011300:Preoperative Care; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000517:prevention & control*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine
keywords: PHMB; antiseptics; hydrogen peroxide; polihexanide; povidone-iodine; traumatic soft tissue wounds; wound infection; wound irrigation