QUALITY IN MEDICINE
Comparative analysis of the antiseptic effectiveness of two commercially available skin disinfectants in cardiac surgery – a preliminary report

Introduction: Appropriate antisepsis of the chest skin is key for successful prophylaxis against incisional surgical site infections in cardiac surgery.

Aim of the study: Comparative analysis of the antiseptic effectiveness of two commercially available agents.

Material and methods: The study involved 91 consecutive patients at the mean age of 66.2 ±9.9 years who underwent elective cardiac surgery. In order to disinfect the chest skin, chlorhexidine (Hibitan) in 70% ethanol was used in group H (n = 46) and povidone-iodine (Braunoderm) in 50% propanol was used in group B (n = 45). The primary clinical endpoint was the occurrence of incisional surgical site infection (either deep or superficial) within the first 30 days after the elective surgery. Moreover, leukocyte counts (WBC) as well as C-reactive protein (CRP) and procalcitonin (PCT) concentrations were analyzed preoperatively and postoperatively – 24, 48, 72 hours, and 7 days after the operation. Additionally, peak values of the aforementioned laboratory parameters (WBC_max, CRP_max and PCT_max) were also estimated in the consecutive measurements.

Results: The primary study endpoint was reached by 4 (8.9%) group B and 2 (4.3%) group H patients. In a single case from group B, a deep surgical site infection affecting the sternum was revealed. The values of all hematological parameters increased markedly after the surgery and were significantly higher (p < 0.05) in group B as compared to group H (WBC_max 15.2 ±2.9 vs. 14.1 ±2.4; CRP_max 190.4 ±41.0 vs. 112.7 ±35.2 mg/l and PCT_max 1.92 ±0.81 vs. 0.95 ±0.34 µg/l, in groups B and H, respectively).

Conclusions: Our findings may indicate that chlorhexidine in 70% ethanol is a more effective surgical site antiseptic agent in cardiac surgery as compared to povidone-iodine in 50% propanol.