RESEARCH
Hip Knee J.
Vol.
No.
2, 2024, pp.
p-ISSN: 2723-7818 e-ISSN: 2723-7826 http://dx.
org/10.
46355/hipknee.
ADHESIVE PLASTIC DRAPES DID NOT PROVE TO PREVENT SURGICAL SITE
INFECTION IN TOTAL KNEE ARTHROPLASTY: A RANDOMIZED CONTROLLED
TRIAL
Ludwig Andretia Powantia Pontoh1.
Ismail Hadisoebroto Dilogo2.
Anggaditya Putra3.
Wahyu Widodo4.
Ihsan Oesman5.
Jessica Fiolin6.
Joshua Alward Herdiman7
2,3,4,5
Department of Orthopaedic and Traumatology.
Fatmawati General hospital.
Faculty of Medicine.
Universitas Indonesia Department of Orthopaedic and Traumatology.
Dr.
Cipto Mangunkusumo General hospital.
Faculty of Medicine.
Universitas Indonesia Jakarta Knee.
Shoulder and Orthopaedic Sport Clinic.
Pondok Indah Hospital Faculty of Medicine.
Dr.
Cipto Mangunkusumo General Hospital.
Faculty of Medicine.
Universitas Indonesia
ABSTRACT
Introduction: Surgical site infection (SSI) prevention is crucial in total knee arthroplasty (TKA) One controllable factor is preventing foreign substances from contaminating the surgical field, for which adhesive draping over surgical drapes is commonly used.
Aim to determine whether using adhesive transparent film dressing has any effect on the occurrence of SSI in TKA.
Methods: We conducted a study comparing 100 TKA, divided into two groups .
ach with 50 participant.
The first group received adhesive plastic draping during TKA, while the second group was the control.
Bacterial aerobic culture swabs were taken before applying the plastic draping and after surgery following skin closure.
Follow-up evaluations were conducted within one month to detect signs of SSI.
The results none of the 100 TKAs included in the study yielded positive bacterial culture results.
One-month post-operative evaluations revealed no signs of SSI in any of the groups.
The conclusion The use of adhesive plastic drapes does not provide any benefit in preventing SSI in TKA.
Skin preparation, prophylaxis, and surgeon preparation protocols are more crucial for SSI prevention than adhesive plastic drapes.
Keywords: adhesive plastic drapes, surgical site infection, total knee arthroplasty This is an open access article under the CCAeBY-SA license.
Article History:
Corresponding Author:
Submission Revision Accepted : March 25th, 2023 : April 22th, 2023 : August 13th, 2024 Ludwig Andretia Powantia Pontoh Department of Orthopaedic and Traumatology.
Fatmawati General hospital.
Faculty of Medicine.
Universitas Indonesia lappontoh@gmail.
CHARACTERISTICS OF INTERTROCHANTERIC FEMUR FRACTURE AT BALI MANDARA GENERAL HOSPITAL
INTRODUCTION
Surgical site infection (SSI) is a potentially Typically, in the presence of metalware, such as in the case of total knee Surgical site infection (SSI) is a potentially Typically, in the presence of metalware, such as in the case of total knee arthroplasty (TKA), although less virulent, the slow-growing pathogens may cause periprosthetic joint infections (PJI).
Despite being one of the most successful procedures of the decade, the risk of PJI remains a serious complication in TKA .
SSI rates in total knee replacement range around 1-2%.
The main bacteria implicated in SSI in clean surgery are those of the skin Hence, the importance of skin preparation to eliminate transient flora and reduce resident flora .
SSI occurs within 30 days after the operation and has at least one of the following: purulent drainage from the superficial incision .
ith/without laboratory confirmatio.
isolated from a culture from the superficial at least one sign/symptom of .
ain/tenderness, swelling, redness, hea.
The route by which these pathogens gain entrance into the wound remains unclear.
However, one potentially controllable route is direct contamination from the surrounding surgical field during the The purpose of surgical drapes is to act as a barrier to external sources of Hence, the use of disposable drapes is now becoming routine .
Furthermore, in decades of recent Copyright A 2024 the author.
| http://thehipkneejournal.
practice, many orthopedic surgeons added a second layer of dressing using adhesive transparent film dressing .
In the end, the primary intention is still the same: to prevent any foreign substance from contaminating the surgical site while securing the operation field.
Various studies have already been conducted on surgical drapes but not on the use of the adhesive transparent film itself, especially in total TKA.
The purpose of this research is to determine whether using adhesive transparent film dressing has any effect on the occurrence of SSI in TKA.
SSI rates in total knee replacement range around 1-2%.
The main bacteria implicated in SSI in clean surgery are those of the skin Hence, the importance of skin preparation to eliminate transient flora and reduce resident flora .
SSI occurs within 30 days after the operation and has at least one of the following: purulent drainage from the superficial incision .
ith/without laboratory confirmatio.
isolated from a culture from the superficial at least one sign/symptom of .
ain/tenderness, swelling, redness, hea.
The route by which these pathogens gain entrance into the wound remains unclear.
However, one potentially controllable route is direct contamination from the surrounding surgical field during the The purpose of surgical drapes is to act as a barrier to external sources of Hence, the use of disposable drapes is now becoming routine .
Furthermore, in decades of recent practice, many orthopedic surgeons added CHARACTERISTICS OF INTERTROCHANTERIC FEMUR FRACTURE AT BALI MANDARA GENERAL HOSPITAL a second layer of dressing using adhesive transparent film dressing .
In the end, the primary intention is still the same: to prevent any foreign substance from contaminating the surgical site while securing the operation field.
Various studies have already been conducted on surgical drapes but not on the use of the adhesive transparent film itself, especially in total TKA.
The purpose of this research is to determine whether using adhesive transparent film dressing has any effect on the occurrence of SSI in TKA.
This study objectives are to ascertain if the application of adhesive transparent film dressing influences the incidence of SSI in total knee arthroplasty TKA.
MATERIAL AND METHODS
We conducted a prospective randomized controlled trial study per the CONSORT criteria .
, comparing 100 knees that received TKA from August 2021 to October 2022 in a single level 1 referral hospital.
One medical doctor divided all participants randomly into two groups right before the Group 1 received adherent plastic adhesive incision drapes, while Group 2 did Both groups were draped using disposable, non-woven drapes.
Senior consultants for knee reconstruction surgery performed all the surgery.
The surgery utilized the standard media parapatellar approach and a pneumatic Our inclusion criteria were patients with surgically indicated minimal deformity knee Our exclusion criteria were knee osteoarthritis with severe deformity, previous or any history of infection in the Copyright A 2024 the author.
| http://thehipkneejournal.
knee, and auto-immune-related knee The adhesive transparent film that we used is OPSITEA Film by Smith & NephewA.
The reasoning behind the adhesive transparent film selection is the moisture vapor's permeable, conformable, and extensible properties of the adhesive transparent film.
Pre-operation intraoperative procedure followed WHO standards and hospital surgical protocol, including chlorhexidine bath, usage of clipper for hair removal, pre-operative antibiotics prophylaxis, disposable surgical drapes, surgeon renewing outer gloves after laying out drapes and before putting on the implant, and usage of pulsed lavage .
During surgery, before the application of the adhesive plastic drapes and after the operation .
ust after the skin closur.
, we performed a bacterial aerobic culture swab .
ith buds and transport mediu.
on the Finally, the post-operative wound was taken care of, observed, and evaluated weekly until one-month post-operative for wound dressing and SSI signs observation.
This study was conducted per the local Institutional Research Board and the Declaration of Helsinki, with registry RESULTS From 100 TKA included in the study, no single culture came back positive for any pathogen from the bacterial culture.
The mean suture removal was 14 A 5.
27 days.
One-month close evaluation of the postoperative wound yielded no sign of any CHARACTERISTICS OF INTERTROCHANTERIC FEMUR FRACTURE AT BALI MANDARA GENERAL HOSPITAL Our participant consists of 72 females and 28 males.
Fifty-seven of the participants were diabetic .
emale 40, male .
, 32 of the participants had hypertension, and 25 male participants had a smoking habit.
patient had hypoalbuminemia or UTI.
demographic data in Table 1.
Table 1.
Baseline Intraoperative Data.
Age .
ears ol.
* BMI .
g/m.
* Operation time .
kin to ski.
* Operative blood loss .
* 48h drain production .
* Hospital length of stay .
* Demographic Mean 64 A 0.
4 A 3.
6 A 19.
3 A 19.
420 A 38.
5,72
*Data were presented in mean A SD
DISCUSSION
Our study indicates that adhesive plastic drapes did not prevent SSI in TKA.
The stagnant level of prevention is due to the extensive steps implemented to prevent SSI, including chlorhexidine baths, prophylaxis antibiotics, skin hair clippers, surgical drapes, pulse lavage, and many other measures .
The accumulation of these preventive measures resulted in no further benefit in applying adhesive plastic drapes to prevent SSI in TKA.
The Cochrane review by Webster J et al.
showed similar results, adhesive plastic drapes application to prevent SSI yields no However, the review by Webster J et included various types of surgery.
Hence, there were many compounding factors .
Moreover, although many of our patients have obesity, diabetes, smoking habits, and other comorbid Copyright A 2024 the author.
| http://thehipkneejournal.
conditions that originally favor infection, there were no incidents of SSI.
Our surgeries had a fair-paced operation time, moderate blood loss during and 48 hours after the surgery, and an average length of Bacterial colonization through drapes is one of the primary sources of surgical site Hence, adequate draping is considered pivotal.
The fact that bacteria can penetrate through drapes renders the non-woven disposable drapes more favorable than other draping types .
Other factors include the length of the surgery, the extent of surgical manipulation, and the distance between surgical sites and foreign particles .
, .
Another crucial factor is the adherence of the draping to the When the surgeon lifted the draping, contamination from the non-disinfected area to the operated area was unavoidable.
Hence, adhesive plastic drapes minimize the probability of this incidence .
However, from this study, we learned that adhesive plastic drapes do not produce further benefits in preventing SSI if all other measures per recommended guidelines have been applied .
Other methods of reducing the risk of SSI in surgeries include iodine-impregnated incision drapes .
D).
A recent systematic review by Sworm et al.
demonstrated that iD prevents SSI in patients with clean or clean contaminated wounds and showed that iD usage in cardiothoracic surgery effectively reduces infections.
However, these findings have no benefit in orthopedic surgeries.
This difference finding might be due to the duration of operation time, which might be longer for CHARACTERISTICS OF INTERTROCHANTERIC FEMUR FRACTURE AT BALI MANDARA GENERAL HOSPITAL the cardiothoracic surgery and hence increase the risk of SSI.
The limitations of this study include a limited sample size and a short follow-up Both limitations occurred due to the limited budget to include more sample size and to perform longer follow-ups.
However, in this research, we highlighted that there is no benefit in applying adhesive plastic drapes to prevent SSI in TKA.
Our findings can also be applied to populations with comorbidities such as diabetes, smoking habits, and obesity, as our sample size is not limited to certain groups of people.
CONCLUSIONS
Adhesive plastic drapes do not benefit SSI infection prevention in TKA.
Skin
preparation, prophylaxis, and surgeon
preparation protocols are more crucial
measures than applying adhesive plastic
REFERENCES