🧴 Preoperative Skin Antisepsis

• Ventriculoperitoneal shunt infection: insights from a single-center comparative analysis
• Ventriculoperitoneal Shunt Surgery in Pediatrics: Does Preoperative Skin Antisepsis with Chlorhexidine/Alcohol Reduce Postoperative Shunt Infection Rate?
• A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters
• Clinical Issues-February 2022
• Current preoperative antisepsis in neurosurgery: an example of the challenges in implementing evidence-based medicine to surgical practice
• Preoperative skin antisepsis with chlorhexidine gluconate versus povidone-iodine: a prospective analysis of 6959 consecutive spinal surgery patients
• Antisepsis of the skin before spinal surgery with povidone iodine-alcohol followed by chlorhexidine gluconate-alcohol versus povidone iodine-alcohol applied twice for the prevention of contamination of the wound by bacteria: a randomised controlled trial
• Systematic Review and Meta-Analysis of Preoperative Antisepsis with Combination Chlorhexidine and Povidone-Iodine

see Skin Cleaning.

Preoperative skin antisepsis is the process of preparing the surgical site to reduce microbial load and minimize the risk of surgical site infections (SSIs).

• Eliminate transient flora
• Reduce resident skin flora
• Prevent introduction of microorganisms into the surgical wound

1. Hair removal: Use clippers just before surgery. Avoid razors.
2. Skin cleaning: Wash soiled areas with soap and water.
3. Application of antiseptic:
   1. Apply in concentric circles from inside outward.
   2. Do not go back over central area.
   3. Allow to dry completely (2–3 min for alcohol-based).
4. Draping: Only after antiseptic is dry.

• Use CHG + alcohol (e.g., 2% CHG + 70% isopropyl alcohol) unless contraindicated.
• Respect contact time:
  1. CHG: ~2 minutes
  2. Povidone-iodine: ~2–3 minutes
• Do not blot dry.

• Avoid CHG on mucosa, eyes, ears or with allergy.
• Alcohol-based agents are flammable → ensure drying before electrocautery.

preoperative_antisepsis_surgery_skin_protocol

Effective preoperative antisepsis is recognized to prevent surgical site infection (SSI), although the definitive method is unclear.

Many have compared chlorhexidine (CHG) with povidone-iodine solution (PVI), but there is emerging evidence for combination usage. Objective  To conduct a systematic review and meta-analysis to evaluate if combination skin preparation (1) reduces colonization at the operative site and (2) prevents SSI compared with single-agent use. Data Sources  A literature search of MEDLINE, Embase, and the Cochrane Database of Clinical Trials was performed. Study Selection  Comparative, human trials considering the combination use of CHG and PVI, as preoperative antisepsis, to single-agent CHG or PVI use were included. Studies were excluded from meta-analysis if the use or absence of alcohol was inconsistent between study arms. Data Extraction and Synthesis  The study was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Main Outcomes and Measures  The primary outcome of the meta-analysis was surgical site infection. The secondary outcome was colonization at the operative site. Results  Eighteen publications with a combination of CHG and PVI use were identified. Of these, 12/14 inferred promise for combination usage, including four trials eligible for meta-analysis. Only one trial reported SSI as its outcome. The remaining three considered bacterial colonization. Combination preparation had a pooled odds ratio for complete decolonization of 5.62 (95% confidence interval 3.2 to 9.7, p  < 0.00001). There was no evidence of heterogeneity (Cochran's Q 2.1, 2 df , p  = 0.35). Conclusions and Relevance  There is emerging, albeit low-quality, evidence in favor of combination CHG and PVI preoperative antisepsis. Further rigorous investigation is indicated ¹⁾.

The antisepsis should be carried out with povidone. Afterwards, benzoin should be applied to better guarantee the area adhesivity.