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Surgical skin preparation — are we just going around in circles?

02 February 2018

Clinical

10 mins read

02 February 2018

Volume 9 · Issue 1

ISSN (print): 2044-0065

ISSN (online): 2052-2959

Abstract

Aseptic care of the skin prior to any breach is of paramount importance to reduce the incidence of surgical site infection (SSI), as each time the skin is incised or punctured a portal of entry for microorganisms exists. The application of an appropriate skin preparation agent is significant, but arguably given less significance is the technique employed to apply the solution itself. Historically, concentric circles were the method of choice for aseptic skin preparation. More recently, a back-and-forth motion is being advocated within the National Health Service (NHS). This article will examine the current literature and seek to determine if evidence exists to support either method demonstrating greater efficacy.

All surgical wounds become contaminated by bacteria, but not all become infected. A critical level of contamination is required before actual infection occurs. Quantitatively, it has been shown that if a surgical site is contaminated with >10⁵ microorganisms per gram of tissue, the risk of surgical site infection is markedly increased (Krizek and Robson, 1975). It has been suggested, however, that this figure may over-simplify the situation somewhat, as there are many factors involved in determining whether a level of wound contamination will result in infection, including the host's own level of resistance (Baines et al, 2012).

Bacterial contamination during a surgical procedure can originate from endogenous sources (resident flora of the patient) or exogenous sources (environmental or transient skin contaminants). However the patient is considered the major source of contamination of the surgical wound, with endogenous staphylococci and streptococci reported as frequently cultured organisms from surgical site infections (Baines et al, 2012).

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