Prospective, Randomized Comparison of Two Skin Preparation Solutions and Resultant Surgical Incise Drape Adhesion to Skin

Background:  

Surgical incise drape adhesion is important at the wound edge where the skin and drape are contiguous with the wound.  In a published study, it was shown that lift at the wound edge may be associated with a 6-fold increase in surgical site infection.  This study evaluated whether the type of preoperative skin prepping solution affects drape skin adhesion.

  Objective:  

It is important to understand whether preoperative skin antiseptic solutions impact the incise drape adhesion to skin. Therefore, this study sought to determine the effect of skin preparation solution on the adhesion of various incise drapes to the skin under a simulated wet saline environment. 

Methods:  

Following randomization, the backs of 22 healthy volunteers were prepped with two commercially available pre-operative skin antiseptic solutions according to manufacturers’ instructions:  ChloraPrep^® with Tint (Scrub Teal^®) 2% w/v chlorhexidine gluconate (CHG) and 70% v/v isopropyl alcohol (IPA) Patient Preoperative Skin Preparation (CP) or 3M™ DuraPrep™ Surgical Solution (Iodine Povacrylex [0.7% available iodine] and Isopropyl Alcohol, 74% w/w) Patient Preoperative Prep (DP).  Three incise drapes were tested: 3M™ Ioban™ 2 Antimicrobial Incise Drape; 3M™ Steri-Drape™ 2 Incise Drape; and ACTI-Gard^® Anti-Microbial Drape.  Drape samples (cut into 3 inches by ½ inch strips) were applied to prepped areas and covered with saline-soaked gauze for 30 minutes to simulate a surgical fluid challenge.  Samples were then mechanically removed from the skin using an adhesion peel tester according to a modified technique based on PSTC-101 International Standard for Peel Adhesion of Pressure Sensitive Tape. Adverse events were monitored and skin was assessed following sample removal to rate redness, skin stripping, and adhesive residue.  The primary outcome variable was drape adhesion.  Analyses were conducted by drape and by prepping solution using a mixed model ANOVA.  If significant differences existed, the Tukey-Kramer method was used for multiple comparisons. 

Results:  

DP solution prepped skin had significantly greater drape adhesion (mean peel strength 181 Newtons/0.5 in) than skin prepped with CP solution (mean peel strength 79 N/0.5 in), P-value<0.0001.  Skin sites showed mild erythema, irrespective of the prepping solution used.  There were no adverse events or instances of skin stripping, residue, or irritation among any of the samples tested. 

Conclusions:  

DP provided significantly greater adhesion, regardless of drape type (p<0.0001).  These data suggest that the type of skin prepping solution may affect drape adhesion and that while DP increases adhesion, it does not appear to cause a clinically significant skin reaction.  For those surgeries where incise drapes are used, choosing a prepping solution that enhances drape adhesion may minimize drape lift and the potential of wound contamination by skin flora.