DuraPrep superior to Chloraprep in lowering positive skin culture in hip arthroplasty patients

ONTARIO: According to research that was published in the Canadian Journal of Surgery, patients who were randomly assigned to receive DuraPrep had a considerably lower incidence of positive skin cultures after skin preparation than patients who had received Chloraprep.

This randomized trial showed that coagulase-negative staph was the most prevalent bacterial species before skin preparation in patients having elective total hip arthroplasty.

With reported rates varying between 0.25% and 2.0%, postoperative infections following arthroplasty are rather rare. The quantity of bacterial skin flora present at the operating site at the time of surgery is a possible risk factor for the emergence of postoperative wound infection.

According to Kurt P. Droll and colleagues, "the use of an effective antibacterial preoperative skin preparation solution is crucial in preventing infections following surgery, although the literature's findings about efficacy are not always applicable to surgery involving the hip."

The current study had two objectives. one was to look at the native bacteria on the hip's skin, and to evaluate how well two surgical skin preparation application works to get rid of bacteria at the hip site in patients undergoing total hip arthroplasty.

For this purpose, from October 2014 to December 2015, the investigators conducted a prospective randomized controlled trial on a group of adult patients who underwent primary total hip replacements at the same facility. Each subject was randomly assigned to receive either ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol) or DuraPrep (0.7% iodophor and 74% isopropyl alcohol) as their surgical skin preparation solution. Prior skin preparation, soon after skin preparation, and following skin closure, samples of both aerobic and anaerobic organisms were collected for culture. A total of 105 patients with 54 in the ChloraPrep group and 51 in the DuraPrep group had complete data collected.

Conclusive highlights of the study:

• Prior to skin preparation, Staphylococcus epidermidis, Corynebacterium, and Micrococcus luteus were the most frequently isolated organisms from the hip.
• 50 patients (93%) in the ChloraPrep group and 48 patients (94%) in the DuraPrep group had positive results from bacterial cultures.
• The proportion of positive culture results overall was substantially lower in the DuraPrep group than in the ChloraPrep group right after skin preparation (14% v. 35%, adjusted relative risk 0.40, 95% confidence interval 0.18-0.85).
• After the wound had healed, there was no discernible difference between the two groups in the percentage of successful culture results.

The authors concluded that when applied, DuraPrep was better than ChloraPrep at removing skin bacteria from the hip, but both treatments were similarly effective when the wound was closed.

To determine whether skin preparation solution has an impact on the frequency of prosthetic joint infection, additional research using bigger samples is necessary, they added.

REFERENCE

Kurt P. Droll, Marcel Abouassaly, Claude Cullinan, David Puskas, Sacha Dubois. Efficacy of surgical skin preparation solutions in hip arthroplasty: a prospective randomized trial. CAN J SURG Nov 2022, 65 (6) E756-E762; DOI: 10.1503/cjs.017221