Preoperative skin antisepsis is an essential component of safe surgery. However, it is unclear how many antiseptic paints are needed to eliminate bacteria prior to incision. This study compared microbial skin counts after two and three antiseptic paints. We conducted a prospective cohort study in non-emergency patients receiving a cardiac/abdominal surgery with standardized, preoperative skin antisepsis consisting of an alcoholic compound and either povidone iodine (PI) or chlorhexidine (CHX). We obtained three skin swabs from the participant’s thorax/abdomen using a sterile template with a 25 cm2 window: After collection of the first swab prior to skin antisepsis, and once the second and third application of PI/CHX had dried out, we obtained a second and third swab, respectively. Our primary outcome was the reduction in microbial skin counts after two and three paints of PI/CHX. Among the 239 enrolled patients, there was no significant difference in the reduction of mean square root-transformed microbial skin counts with three versus two paints (P = 0.2). But distributions of colony forming units (CFUs) decreased from paint 2 to 3 in a predefined analysis (P = 0.002). There was strong evidence of an increased proportion of patients with zero CFU after paint 3 versus paint 2 (P = 0.003). We did not identify risk factors for insufficient reduction of microbial skin counts after two paints, defined as the detection of > 5 CFUs and/or ≥ 1 pathogens. In non-emergency surgical patients, three antiseptic paints may be superior to two paints in reducing microbial skin colonization prior to surgery.

中文翻译：

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安全准备手术区域是否需要三种防腐涂料？一项针对239名患者的前瞻性队列研究。

术前皮肤防腐是安全手术的重要组成部分。然而，目前尚不清楚在切口前需要多少消毒涂料来消除细菌。这项研究比较了两种和三种防腐涂料后的微生物皮肤计数。我们对接受心脏/腹部手术的非急诊患者进行了一项前瞻性队列研究，这些患者接受了标准化的术前皮肤消毒，其中包括酒精性化合物和聚维酮碘（PI）或洗必泰（CHX）。我们使用具有25 cm2窗口的无菌模板从参与者的胸/腹中获得了3个皮肤拭子：在皮肤防腐之前收集了第一个拭子，并且在第二次和第三次PI / CHX应用干透后，我们获得了第二和第三拭子。我们的主要结果是经过两次和三次PI / CHX涂料后微生物皮肤数量的减少。在239名入组患者中，使用三种涂料与两种涂料相比，均方根转化微生物皮肤计数的减少没有显着差异（P = 0.2）。但是在预先定义的分析中，菌落形成单位（CFU）的分布从涂料2减少到3（P = 0.002）。有强有力的证据表明，与涂料2相比，涂料3后CFU为零的患者比例有所增加（P = 0.003）。我们没有发现两种涂料后微生物皮肤计数不能充分减少的危险因素，这被定义为检测> 5个CFU和/或≥1个病原体。对于非紧急手术患者，在减少手术前微生物皮肤定植方面，三种防腐涂料可能优于两种涂料。