Addition of an Acrylate Copolymer to 2% CHG/70 % IPA Preoperative Skin Preparation Decreases Drape Lift.

Author(s):

Joan Paulson; Dan Morse; Assumpta Bennaars-Eiden

Background:

Incise drape lift occurring during surgery may be associated with an increased risk of surgical infection rates. Drape lift is impacted by the skin preparation solution applied to the surgical site.

Hypothesis:

Our null hypothesis is that there is no difference in drape lift on skin prepared with 2% chlorhexidine gluconate (CHG)/70% isopropyl alcohol (IPA) compared to 2% CHG/70% IPA with an acrylate copolymer (polymer).

Methods:

A randomized, controlled study used a simulated knee arthroplasty surgical model to evaluate drape lift with 2 CHG/IPA based skin preparation solutions applied in combination with an iodine-impregnated antimicrobial incise drape. Each skin prep, 2% CHG/70% IPA (polymer) and 2% CHG/70% IPA, was applied to 30 healthy volunteers’ knees. To simulate the wound incision edge, strips of iodine-impregnated incise drapes were applied to each side of the midline of each prepped knee. To simulate stresses experienced by the drape during surgery under dry and wet conditions, knees were flexed in dry conditions, then under wet saline gauze, followed by saline lavage. Areas of drape lift were marked and measured using ImageJ software and drape lift frequency observed between the 2 skin preps was compared in each condition. Ease of drape removal and skin irritation immediately after removal was scored.

Results:

Application of 2% CHG/70% IPA (polymer) resulted in significantly lower frequency and mean total area of drape lift after saline lavage when compared to 2% CHG/70% IPA (frequency: 9/60 [15%] vs. 18/60 [30%], respectively, P=0.049; mean total area lifted: 104 mm² vs 140 mm² respectively, P=0.036). The perceived drape removal force was mild (grade 1) and slightly lower for 2% CHG/70% IPA (polymer) (1.15) compared to 2% CHG/70% IPA (1.28) but not statistically significant (P=0.057).

Conclusions:

Addition of an acrylate copolymer to a 2% CHG/70% IPA preoperative skin preparation resulted in decreased drape lift of the iodine impregnated surgical drape to skin in this surgical model.