Authors:DR. Osmon, AD. Hanssen, RT Trousdale, MW Pagnano, EF Berbari, C Jacobson*, J Shaw*
Title:The efficacy of 3M TM DuraPrepTMSurgical Solution plus 3MTM Ioban TM 2 antimicrobial incise drapes for the prevention of wound contamination during total joint replacement (TJR)
Addresses: Mayo Medical Center, Rochester, MN, 3M Corporation*
Purpose: Surgical wound infection remains an infrequent but serious complication of TJR. We evaluated the efficacy of a preoperative antiseptic skin care regimen consisting of 3MTM DuraPrep TM Surgical Solution plus 3M TM Ioban TM 2 antimicrobial drapes (DP) for the prevention of wound contamination during TJR.
Methods:We conducted a single-center, randomized, controlled clinical trial to evaluate the ability of DP plus Ioban 2 drapes vs. povidone iodine impregnated skin prep tray by Allegiance plus 3M TM Ioban TM 2 antimicrobial drapes (PVP-I) to decrease the proportion of patients with a contaminated wound at the time of wound closure following TJR. The primary endpoint was the proportion of patients with a contaminated wound at the time of wound closure following TJR. The cost of the skin preparation included the cost of DP or PVP-I and OR time for prepping
Results:176 evaluable adult patients undergoing a primary or revision TKA or THA were randomized to either DP or PVP-I. The proportion of patients with a contaminated wound was not statistically different between the two groups [DP 28% vs. PVPI 36.4% (p = 0.26)]. In contaminated wounds the median CFU count was low: 2 cfu/plate (range 1-1408). The mean drape lift in the DP group was significantly less than PVPI group [DP 1.5cm2 vs. PVPI 9.9cm2 (p < 0.0001)]. The mean total prepping time in the DP group was significantly less than PVPI group [DP 3.5 minutes vs. PVPI 9.68 minutes (p < 0.0001)]. The mean cost of prepping, was significantly lower for the DP group than PVPI group [DP $93.36 vs PVPI $248.91 (p < 0.0001)]. There was no significant difference between the two groups in all-adverse events (AE) [DuraPrep 9 (10.3%) vs. PVPI 8 (8.6%) (p = 0.80)] or AE possibly or probably related to treatment [DuraPrep 3 (3.4%) vs. PVPI 1 (1.1%) (p = 0.35)].
Discussion:The preoperative antiseptic skin regimen of DuraPrep Solution plus Ioban2 Incise Drapes is equivalent to PVP-I skin prep plus Ioban 2 Incise Drapes for the prevention of wound contamination during TJR. Improved drape lift, timesavings, and cost may then influence the choice between the two regimens.