Authors: Bady S, Wongworowat M
Title: Effectiveness of Ioban versus Integuseal Barrier Preparations for Surgical Sites in an Ovine Model
Institution: Loma Linda University, Loma Linda CA
Purpose: We compared the effectiveness of Ioban adhesive barrier versus Integuseal in preventing skin flora contamination of surgical wounds.
Methods: We obtained freshly euthanized sheep which were euthanized for other reasons. Prior to beginning the study we obtained approval from the Institutional Animal Care and Use Committee. A commercial shaver was used to remove the wool from the side of the sheep. Blades were then used to remove the wool from the skin surface until a smooth consistency was obtained. Care was taken not to cut the skin surface with the blade. The skin was thoroughly sanitized with alcohol. Thirty circles (diameter = 11.3mm, area = 1 cm2) were drawn on the skin. A suspension of Staphylococcus aureus (strain 12600) was cultured in 15 ml of nutrient broth. The result was a Staphylococcus aureus suspension at a concentration of 10^8 colony forming units/mL. The suspension was agitated. An alliquots of 15 microliters was applied to the center of each circle using a micropipette. The bacterial suspension was evenly distributed on the skin surface within the marked area using the pipeette tip. A new tip was used for each circle. The suspension was allowed to dry for five minutes. Vi-Drape adhesive spray was equally sprayed on the entire flank to facilitate Ioban adhesion. Integuseal was then applied on ten of the samples, Ioban on another ten, and the final ten served as controls. Using a size 10 scalpel, a 11.3mm incision along the diameter of the sample was made with a depth down to the dermal layer. Using a sterile applicator, a culture swab was taken from the epidermal/dermal surface along the length of the wound. The applicator tip was then cut using sterile scissors into 10mL sterile saline. A sample of the saline was taken after centrifugation and spread evenly on blood agar plates after 10(-2) dilution. The plates were then incubated for 24 hours. The numbers of colonies per agar plate were counted. This study was repeated on a second animal. The location of the placement of the circles were randomized. Overall, twenty samples from each group were obtained.
Results: Samples from the control group yielded an average of 82.7 +/- 93.3 colony forming units (CFUs). Cultures obtainined from areas covered with Ioban produced 108.3 +/- 90.0 CFUs. When Integuseal was used, samples yielded 0.3 +/- 0.6 CFUs. Post hoc analysis against the control group revealed no significant difference to the Ioban group, whereas Integuseal produced significantly lower CFUs.
Discussion and Conclusion: The goal of this project was to compare the effectiveness of colony?count reduction in various surgical site preparation techniques. . The main purpose of this study was to assess colony count reducing properties of the drapes rather than assessing effectiveness of a surgical prep sterilization solution. Therefore, we chose to apply the surgical drapes without using a prep solution to maintain the highest colony counts possible to see if the drape preparations themselves have colony count reducing capability. Our findings suggest that the use of iodophorm?impregnated plastic drapes did not reduce colony counts in and of itself. Our study, specifically looking at the skin edge to determine whether or not the incised drape or other drape methods actually reduce colony counts reveal that the iodophor?impregnated incise drape makes no difference at the skin edge itself. Our study revealed that bacterial immobilization using Integuseal cyanoacrylate Microbial Sealant adequately immobilizes bacteria to reduce bacterial mobility at the skin edge itself where surgery is performed.In conclusion, we find that Ioban does not in and of itself decrease actual colony count, whereas Integuseal decreases bacterial mobility and contamination.