Skip to main content

Advertisement

SpringerLink
Log in

Microbial sealants do not decrease surgical site infection for clean-contaminated colorectal procedures

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Surgical site infections (SSI) are costly complications that may cause significant morbidity and increase the cost of care, particularly in colorectal surgery. Microbial sealants (MS) are a new class of wound barriers aimed at decreasing SSI; however, there is only evidence of benefit in clean class 1 procedures. Based on its success in class 1 procedures, we hypothesized that a microbial sealant could reduce the rate of SSI by half for clean-contaminated colorectal procedures (class 2).

Methods

This was a single institution, multihospital, prospective, randomized study approved by the institutional review board. The primary objective was to determine the rate of SSI when microbial sealant (InteguSeal© Kimberly-Clark) is used compared to control (no microbial sealant). Data collected included: open versus laparoscopy, age, body mass index (BMI), diabetes and morbidity [American Society of Anesthesiologists (ASA) class], hospital readmission, reoperation and wound dehiscence. Enrolled subjects received the same preoperative mechanical bowel preparation with oral antibiotics, operative skin preparation (Chloraprep), Surgical Care Improvement Project guidelines implementation), and postoperative care glycemic control for diabetics.

Results

A total of 100 subjects were recruited over 15 months (MS-50; no MS-50). The overall incidence of SSI was 12 %, 14 % (7/50) in the MS versus 10 % (5/50) in the no MS group (p = 0.545). SSI incidence with and without microbial sealant was not significantly different in either the open or the laparoscopic subgroup. Laparoscopy decreased absolute risk of SSI by 16 %. Secondary data (age, BMI, diabetes, ASA) and tertiary data (readmission, reoperation, wound dehiscence) were positively correlated with SSI.

Conclusions

Microbial sealant as employed in this study did not appear to offer any benefit in a class 2 (clean contaminated) operative procedure when perioperative care is standardized. The relative benefit of laparoscopy was also confirmed but unaffected by use of the microbial sealant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Raymond DP, Pelletier SJ, Crabtree TD, Schulman AM, Pruett TL, Sawyer RG (2001) Surgical infection and the aging population. Am Surg 67:827–833

    CAS  PubMed  Google Scholar 

  2. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB (2009) Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 37:387–397

    Article  PubMed  Google Scholar 

  3. http://www.usinflationcalculator.com/

  4. Smith RL, Bohl JK, McElearney ST et al (2004) Wound infection after elective colorectal resection. Ann Surg 239:599–605 discussion 605–607

    Article  PubMed Central  PubMed  Google Scholar 

  5. Murray BW, Cipher DJ, Pham T, Anthony T (2011) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg 202:558–560

    Article  PubMed  Google Scholar 

  6. Cheng KP, Roslani AC, Sehha N et al (2012) ALEXIS O-ring wound retractor vs. conventional wound protection for the prevention of surgical site infections in colorectal resections. Colorectal Dis 14:e346–e351

    Article  CAS  PubMed  Google Scholar 

  7. Webster J, Alghamdi AA (2007) Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev 17:CD006353

    Google Scholar 

  8. Kramer A, Assadian O, Lademann J (2010) Prevention of postoperative wound infections by covering the surgical field with iodine-impregnated incision drape (Ioban 2). GMS Krankenhhyg Interdiszip 21:5

    Google Scholar 

  9. Dohmen PM, Gabbieri D, Weymann A, Linneweber J, Geyer T, Konertz W (2011) A retrospective non-randomized study on the impact of INTEGUSEAL, a preoperative microbial skin sealant, on the rate of surgical site infections after cardiac surgery. Int J Infect Dis 15:e395–e400

    Article  CAS  PubMed  Google Scholar 

  10. Iyer A, Gilfillan I, Thakur S, Sharma S (2011) Reduction of surgical site infection using a microbial sealant: a randomized trial. J Thorac Cardiovasc Surg 142:438–442

    Article  PubMed  Google Scholar 

  11. Dohmen PM, Gabbieri D, Weymann A, Linneweber J, Konertz W (2009) Reduction in surgical site infection in patients treated with microbial sealant prior to coronary artery bypass graft surgery: a case–control study. J Hosp Infect 72:119–126

    Article  CAS  PubMed  Google Scholar 

  12. von Eckardstein AS, Lim CH, Dohmen PM (2011) A randomized trial of a skin sealant to reduce the risk of incision contamination in cardiac surgery. Ann Thorac Surg 92:632–637

    Article  Google Scholar 

  13. Towfigh S, Cheadle WG, Lowry SF, Malangoni MA, Wilson SE (2008) Significant reduction in incidence of wound contamination by skin flora through use of microbial sealant. Arch Surg 143:885–891 discussion 891

    Article  PubMed  Google Scholar 

  14. Dromzee E, Tribot-Laspière Q, Bachy M, Zakine S, Mary P, Vialle R (2012) Efficacy of integuseal for surgical skin preparation in children and adolescents undergoing scoliosis correction. Spine (Phila Pa 1976) 37:E1331–E1335

  15. Kenny, David A (1987) Statistics for the social and behavioral sciences. Boston. Chapter 13, page 215, in: Little, Brown. ISBN 0-316-48915-8

  16. Rosenberger LH, Politano AD, Sawyer RG (2011) The surgical care improvement project and prevention of post-operative infection, including surgical site infection. Surg Infect (Larchmt) 12:163–168

    Article  Google Scholar 

  17. Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149:830–840

    Article  PubMed  Google Scholar 

  18. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608

    Article  CAS  PubMed  Google Scholar 

  19. Hendren S, Fritze D, Banerjee M (2013) Antibiotic choice is independently associated with risk of surgical site infection after colectomy: a population-based cohort study. Ann Surg 257:469–475

    Article  PubMed  Google Scholar 

  20. Bellows CF, Mills KT, Kelly TN, Gagliardi G (2011) Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials. Tech Coloproctol 15:385–395

    Article  CAS  PubMed  Google Scholar 

  21. Cannon JA, Altom LK, Deierhoi RJ et al (2012) Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections. Dis Colon Rectum 55:1160–1166

    Article  PubMed  Google Scholar 

  22. Deierhoi RJ, Dawes LG, Vick C, Itani KM, Hawn MT (2013) Choice of intravenous antibiotic prophylaxis for colorectal surgery does matter. J Am Coll Surg 217:763–769

    Article  PubMed  Google Scholar 

  23. Fry DE (2011) Colon preparation and surgical site infection. Am J Surg 202:225–232

    Article  PubMed  Google Scholar 

  24. Englesbe MJ, Brooks L, Kubus J (2010) A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics. Ann Surg 252:514–519 discussion 519–520

    PubMed Central  PubMed  Google Scholar 

  25. Krapohl GL, Phillips LR, Campbell DA Jr (2011) Bowel preparation for colectomy and risk of Clostridium difficile infection. Dis Colon Rectum 54:810–817

    Article  PubMed Central  PubMed  Google Scholar 

  26. Darouiche RO, Wall MJ Jr, Itani KM et al (2010) Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 362:18–26

    Article  CAS  PubMed  Google Scholar 

  27. Fujii T, Tabe Y, Yajima R (2011) Effects of subcutaneous drain for the prevention of incisional SSI in high-risk patients undergoing colorectal surgery. Int J Colorectal Dis 26:1151–1155

    Article  PubMed  Google Scholar 

  28. Sehgal R, Berg A, Figueroa R et al (2011) Risk factors for surgical site infections after colorectal resection in diabetic patients. J Am Coll Surg 212:29–34

    Article  PubMed  Google Scholar 

  29. Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211:232–238

    Article  PubMed  Google Scholar 

  30. Rea JD, Cone MM, Diggs BS, Deveney KE, Lu KC, Herzig DO (2011) Utilization of laparoscopic colectomy in the United States before and after the clinical outcomes of surgical therapy study group trial. Ann Surg 254:281–288

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The microbial sealant InteguSeal© was generously provided free of charge by Kimberly-Clark, Inc.

Author information

Authors and Affiliations

  1. Keck School of Medicine of USC, 1441 Eastlake Ave, Suite 7418, Los Angeles, CA, 90033, USA

    M. Doorly, J. Choi, A. Floyd & A. Senagore

Authors
  1. M. Doorly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Floyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Senagore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Doorly.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doorly, M., Choi, J., Floyd, A. et al. Microbial sealants do not decrease surgical site infection for clean-contaminated colorectal procedures. Tech Coloproctol 19, 281–285 (2015). https://doi.org/10.1007/s10151-015-1286-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-015-1286-5

Keywords

Search

Navigation