PICASSo: PVP Iodine vs Chlorhexidine in Alcohol for Disinfection of the Surgical Site
Study Details
Study Description
Brief Summary
Prospective cluster-randomized multicenter cross-over trial to prove non-inferiority of PI compared to CHX in preoperative skin antisepsis
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 4 |
Detailed Description
Surgical site infections (SSIs) are the most common nosocomial infections in surgical patients causing significant increases in morbidity, mortality, and health care costs. As they are usually caused by components of the normal skin flora, disinfection of the surgical site with an antiseptic skin preparation is standard practice prior to any surgical intervention. The most commonly used disinfectants are either chlorhexidine in alcoholic solution (CHX) or PVP iodine in alcoholic solution (PI) This prospective cluster-randomized multicenter cross-over trial is to prove non-inferiority of PI compared to CHX in preoperative skin antisepsis in abdominal and cardiothoracic surgery in regard of SSIs.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Cardiothoracic surgery - PI disinfection
|
Drug: PI Disinfection
PI (Braunoderm® from B.Braun or Betaseptic® from Mundipharma) is applied prior to surgery on the patient's skin with the use of swabs. The product is applied three times. The cumulative residence time is a minimum of 3 minutes. The application is performed according to standard procedures of the participating centers and according to manufacturer's recommendations
|
| Active Comparator: Cardiothoracic surgery - CHX disinfection
|
Drug: CHX disinfection
CHX (Softasept® Chlorhexidine solution 2% coloured, from B. Braun Medical AG) is applied three times on the patient's skin with the use of swabs. The cumulative residence time is a minimum of 3 minutes. The application is performed according to standard procedures of the participating centers and according to manufacturer's recommendations
|
| Active Comparator: Abdominal surgery - PI disinfection
|
Drug: PI Disinfection
PI (Braunoderm® from B.Braun or Betaseptic® from Mundipharma) is applied prior to surgery on the patient's skin with the use of swabs. The product is applied three times. The cumulative residence time is a minimum of 3 minutes. The application is performed according to standard procedures of the participating centers and according to manufacturer's recommendations
|
| Active Comparator: Abdominal surgery - CHX disinfection
|
Drug: CHX disinfection
CHX (Softasept® Chlorhexidine solution 2% coloured, from B. Braun Medical AG) is applied three times on the patient's skin with the use of swabs. The cumulative residence time is a minimum of 3 minutes. The application is performed according to standard procedures of the participating centers and according to manufacturer's recommendations
|
Outcome Measures
Primary Outcome Measures
- Surgical site infections (SSIs) [occurrence of surgical site infections is evaluated at three time points: at time of dismissal from the hospital (approx. 1 week after surgical intervention); 30 days after abdominal and cardiac surgery; 1 year for cardiac surgery]
Comparison of SSI rates between the two groups using standard chi-square test. Presence of SSIs for abdominal and cardiac surgeries as defined by Swiss society of hospital epidemiologists (Swissnoso) according to National Healthcare Safety Network (NHSN) criteria. Analysis will be performed using the final SSI rate (30 days for abdominal, 30 days/1 year for cardiac surgery) and according to the different types of infections. Infection ratio will be calculated as crude ratio as well as adapted to the National Nosocomial Infections Surveillance System (NNIS) score. The method of aggregation for the combined SSI rate for both types of surgery together will be a weighted average based on the proportion of SSIs from each surgery type. The measure includes no scale.
Secondary Outcome Measures
- Type of SSI: superficial, deep, organ-space [three time points: at time of dismissal from the hospital (approx. 1 week after surgical intervention); 30 days after abdominal and cardiac surgery; 1 year for cardiac surgery]
Type of SSI: superficial, deep, organ-space; DEFINITIONS OF SSI: For surveillance classification purposes, SSIs are divided into incisional SSIs and organ/space SSIs. Incisional SSIs are further classified into those involving only the skin and subcutaneous tissue (called superficial incisional SSIs) and those involving deep soft tissues of the incision (called deep incisional SSIs (e.g., fascial and muscle layers)). Organ/space SSIs involve any part of the anatomy (e.g., organs or spaces), other than the incision, opened or manipulated during the operative procedure.
- Body Mass Index (BMI) [day of surgery]
Subgroup analysis stratified by patient factors (i.e. BMI). Weight and height will be combined to report BMI in kg/m^2).
- Change in hemoglobin (g/l) [day of surgery]
Subgroup analysis stratified by laboratory parameters: hemoglobin (g/l)
- Mortality [in-hospital (approx. 1 week from surgical intervention) and 30 day for abdominal surgery; in-hospital (approx. 1 week from surgical intervention), 30 day and 365 day for cardiac surgery]
death rate
- Timing of antimicrobial prophylaxis [day of surgery]
Timing of antimicrobial prophylaxis (antibiotic, dose,time of application)
- Duration of surgery [time from start to stop of surgical intervention]
Duration of surgery
- Wound contamination -class according to Centers for Disease Control and Prevention(CDC) [three time points: at time of dismissal from the hospital (approx. 1 week after surgical intervention); 30 days after abdominal and cardiac surgery; 1 year for cardiac surgery]
Wound contamination -class according to Centers for Disease Control and Prevention(CDC)
- American Society of Anesthesiologists (ASA) -score [day of surgery]
ASA physical status classification system is a system for assessing the fitness of patients before surgery. These are: Healthy person. Mild systemic disease. Severe systemic disease. Severe systemic disease that is a constant threat to life. A moribund person who is not expected to survive without the operation. A declared brain-dead person whose organs are being removed for donor purposes.
- Change in creatinine (ymol/l) [in- hospital stay (approx. 1 week from surgical intervention)]
Subgroup analysis stratified by laboratory parameters: creatinine (ymol/l)
- Change in leukocytes (x10^9/l) [in- hospital stay (approx. 1 week from surgical intervention)]
Subgroup analysis stratified by laboratory parameters: leukocytes (x10^9/l)
- Change in concentration for C reactive Protein (CRP) (mg/l) [in- hospital stay (approx. 1 week from surgical intervention)]
Subgroup analysis stratified by laboratory parameters: CRP (mg/l)
- National Nosocomial Infections Surveillance System (NNIS) index [in- hospital stay (approx. 1 week from surgical intervention)]
NNIS index takes into account 3 risk factors, and each is awarded 1 point: contaminated or dirty-infected surgical wound, American Society of Anesthesiology (ASA) score greater than 2 and surgery duration longer than T (where T is defined as the 75th percentile of the average time for a surgical procedure).
Eligibility Criteria
Criteria
Inclusion Criteria:
- undergoing cardiac or certain types of abdominal surgery (colorectal surgery, cholecystectomy, herniotomy, appendectomy and bariatric surgery) which are routinely followed up by the study Centers during the study period
Exclusion Criteria:
-
contraindication to the use of either one of the compounds ( CHX: intolerance to any of the compounds of the preparation, application on cornea, wounds or mucosal Membrane. PI: hyperthyroid disease, intolerance to any of the compounds, iodine allergy, 2 weeks prior to radio- iodine treatment, Dermatitis herpetiformis Duhring, application on cornea, wounds or mucosal membranes)
-
Emergency surgical Intervention
-
Patients refusing General consent for use of personal data
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University Hospital Basel, Division of Infectious Diseases and Hospital Epidemiology | Basel | Switzerland | ||
| 2 | University Hospital of Bern; Division of Infectious Diseases and Hospital Epidemiology | Bern | Switzerland | 3010 | |
| 3 | University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology | Zurich | Switzerland | 8091 |
Sponsors and Collaborators
- University Hospital, Basel, Switzerland
- Swiss National Science Foundation
Investigators
- Principal Investigator: Andreas Widmer, Prof. Dr. MD, University Hospital Basel, Division of Infectious Diseases and Hospital Epidemiology
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2018-00962; me17Widmer2