At least 5% of patients undergoing a surgical procedure will go on to develop a surgical site infection1. These infections can lengthen a patient’s stay, increase costs, and even be deadly.
It is estimated that around 30% of these infections can be prevented through the application of existing knowledge and tools9. 3M™ Ioban™ Antimicrobial Incise Drapes2 are one of these tools, and one of the most underused tools in our armoury. With new evidence to demonstrating the antimicrobial activity of Ioban drapes and their role in reducing in SSI rates, now is the perfect time to incorporate their use into your surgical practice.
There is a vast array of evidence which demonstrates the negative effect of surgical site infections; from increased morbidity, cost of care and length of hospital, to decreased patient satisfaction scores and lower quality of life.
Evidence shows that nearly 5% of surgical patients will go on to develop an SSI1 and it is estimated that the treatment of SSIs costs the NHS around £700m a year10.
Since we know that the risk of acquiring a SSI is directly linked to the number of skin microbes on a patient’s skin, appropriate skin preparation before and throughout surgery is key.
The Centers for Disease Control and Prevention (CDC) state that the risk of surgical site infection (SSI) can be measured according to three distinct viariables:
The resistance of the host i.e. how good the patient's immune system is.
The dose of microbial contamination i.e. how many microbes there are.
The virulence of contaminating microbes i.e. how infectious the microbes are.
Whilst skin preps reduce microbes on the skin surface, bacteria in the deeper skin layers will remain. Over time these microbes will recolonise the skin surface. If these microbes then contaminate the surgical wound; a SSI is likely to occur.
A new study from Elliott et al (2015) now demonstrates that iodine released from 3M™ Ioban™ Antimicrobial Incise Drapes2 is able to penetrate the deeper skin layers at a concentration required for microbial death11.
J. Antimicrobial Chemotherapy. 2015.11
To demonstrate the permeation of iodine into the skin
Human skin was inoculated with MRSA epidemic strain EMRSA-15 and an Ioban drape was then applied to the skin surface for six hours. The drape material was then removed from the skin surface, and the skin samples were immediately cryogenically frozen. Samples of skin 100µm in diameter (to a depth of 1500µm) were then sectioned. Iodine was then extracted from each section, and the concentration of iodine measured.
Iodine from the Ioban drapes was found to be present at levels required for microbial death at a depth of 1000 -1100µm – thereby reaching the deeper skin layers. Chlorhexidine Gluconate (CHG) skin prep by contrast, is able to permeate skin at a concentration required for microbial death to a depth of only 300µm.
At the 2016 International Federation of Infection Control Congress, Professor Elliott gave a keynote speech on the findings from his skin permeation study.
This 30 minute webinar is available for you to view right here.
Povidone-iodine (PI) and chlorhexidine gluconate (CHG) are two of the most commonly used antimicrobials in healthcare. Historically, some clinicians have avoided combining the two antiseptics due to the lack of evidence into the impact a combined approach would have on antimicrobial activity. Subsequently, some clinicians may have avoided using CHG skin prep followed by the application of a 3M™ Ioban™ Antimicrobial Incise Drape2.
In 2010 Andersen et al conducted a study to assess whether CHG and PI are more effective combined or alone12. Data from this study and two other reports in literature have suggested that there may be clinical benefits to using both agents when preparing skin for surgery – supporting the use of CHG skin prep followed by the application of an Ioban drape.
American J of Inf Cont. 2010 12
Determine whether the activity of chlorhexidine gluconate (CHG) and povidone iodine (PI) is greater when combined together, or used alone.
Bacterial cultures of six clinically relevant pathogens were cultivated and CHG and PI were applied to the culture individually and as a combined agent. The kill activity of the antiseptics alone and combined was then assessed. In addition, MSSA was applied to porcine tissue and then treated with CHG, PI or both antiseptics. The number of bacteria on the tissue after 2 hours was then counted.
Data from the pathogenic cultures demonstrated that combining CHG and PI had no negative effect on antisepsis. Results from the porcine tissue study demonstrated that the use of CHG and PI combined was superior to the use of either agent alone. The author concluded “there may be clinical benefits to using a combination of CHG and PI to prepare skin prior to surgery”.
3M™ Ioban™ Antimicrobial Incise Drapes2 work by reducing the number of skin microbes in the deeper skin layers of a surgical patient. The drapes also immobilise residual bacteria on the skin surface, preventing migration into the wound during surgical procedures.
This activity of an Ioban drape helps to reduce the risk of surgical site infections, and several studies have documented this impact.13, 14
J Cardiovasc Trans. Res. 2015.13
Examine the efficacy in preventing SSI in cardiac surgery, using two different drapes; an iodine impregnated drape (Ioban drape) and a non-iodine impregnated drape (standard drape). The cost effectiveness of each drape was also evaluated.
A total of 1616 patients undergoing cardiac surgery were matched in terms of risk factors. 808 patients received Ioban drapes, and the other group of 808 patients received a standard drape.
The overall costs of treating each patient group was then measured, taking into consideration the cost of drapes, antibiotic treatment, VAC therapy, sternal wound revision staff salaries and extended hospital stay.
SSI rates for the group which received the standard drape was measured to be 6.5%. In comparison the SSI rate for the group which received the Ioban drape was 1.9%; a statistically significant difference.
Results from the cost analysis demonstrated that the use of an Ioban drape offered a total cost saving of €773,495 - equivalent to €957 per patient.
To investigate the risk factors associated with surgical site infection in liver surgery, with special attention paid to the use of iodophor impregnated drapes (Ioban drapes).
A retrospective study on 296 patients undergoing liver surgery. A total of 122 patients received an Ioban drape, whilst 174 patients received no drape at all. The SSI rates across both groups was then compared.
SSI rates in the patient group who were not treated with a drape was measured at 12.1%. In contrast, the SSI rate in the patient group who were treated with an Ioban drape was 3.1%; a statistically significant difference. The author concluded “the non-use of iodophor drapes is a possible risk factor for wound infection after liver surgery”.
At the 2016 International Federation of Infection Control Congress, Tomaso Bottio, an author from the Bejko Study presented the key findings from his research into the “efficacy and cost of iodine impregnated drapes”.
3M™ Ioban™ Antimicrobial Incise Drapes2 provide continuous broad spectrum antimicrobial activity throughout surgery across in a wide range of specialties*, including:
See what clinicians say about reducing the risk of SSI and the use of Ioban
** Terms and conditions apply
* Ioban is not recommended for use on neonatals, mucous membranes or with patients with a known sensitivity to iodine
** Terms and conditions: Ioban Trial kits are available to medical professionals in the UK and Ireland. One trial kit per medical professional. No cash alternative can be offered for the free trial kit. 3M reserves the right to change or cancel the promotion at any time. Offer available while stocks last.
1. Smyth ET et al. (2008) Four Country Healthcare Associated Infection Prevalence Survey 2006: Overview of the results. Journal of Hospital Infection; 69:230–48.
2. Plowman R, Graves N, Griffin M et al (1999) The socio-economic burden of hospital acquired infection. London: Public Health. Laboratory Service.
3. Whitehouse et al. (2002) The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol; 23(4):183–189.
4. Kirkland et al (1999) The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol; 20(11): 725–730.
5. Coello R, et al (2005) Adverse impact of surgical site infections in English hospitals J. Hosp. Infect 60: 93–103.
6. NICE Clinical Guidelines, No. 74. Prevention and treatment of surgical site infection.
7. Cars O, Nordberg P. Antimicrobial resistance – the faceless threat. International Journal of Risk and Safety in Medicine. 2005; 12:103-110.
8. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.
9. National audit office (2000). The management and control of hospital acquired infection in acute NHS trusts in England. London: The Stationery Office.
10. Under the Knife Report, 2011: Taking a zero tolerance approach to preventable surgical site infections in UK hospitals
11. Elliott et al. Antimicrobial activity and skin permeation of iodine present in an iodine-impregnated surgical incise drape. J. Antimicrobial Chemotherapy. 2015.
12. Andersen et al. Efficacy of concurrent application of chlorhexidine gluconate and povidone iodine against six nosocomial pathogens. American J of Inf Cont. 2010; 38(10): 826-831
13. Bejko et al. Comparison of efficacy and cost of iodine impregnated drape vs. standard drape in cardiac surgery: Study in 5100 patients. J Cardiovasc Trans. Res. 2015; 8:431-437
14. Yoshimura et al. Plastic iodophor drape during liver surgery operative use of the iodophor impregnated adhesive drape to prevent wound infection during high risk surgery. World J. Surgery. 2003; 27:685-688