No benefit to dilute betadine soak, scrub added to foot and ankle surgery skin preparation
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SAN DIGEO — A dilute betadine soak and scrub added to a standard alcohol and chlorhexidine preparation did not decrease positive bacterial culture rates from the hallux nailfold, study results showed.
Nasima Mehraban, MD, and colleagues at Midwest Orthopaedics at Rush studied these skin treatments in a prospective, randomized controlled trial that included 242 patients categorized into an intervention group and a control group, the goal of which was to achieve consensus regarding the most effective skin antiseptic technique for reducing bacterial load in patients undergoing foot and ankle procedures.
Researchers wrote in the abstract, “The hallux nailfold is one of the most difficult to sterilize areas prior to orthopedic foot and ankle surgery.”
Mehraban, who presented results at the American Academy of Orthopaedic Surgeons Annual Meeting, here, told Healio Orthopedics, “There is no consensus as to what is the optimal antiseptic solution for foot and ankle orthopedic surgery.”
In determining what differences would be enough to change guidelines and institutional practices, calculations showed “we needed 242 patients to show a 95% confidence interval. That’s how many patients we did get,” she said.
Both groups of patients were blinded to the skin preparation to which they were randomized, Mehraban said.
The intervention group underwent a betadine soak and scrub, in which 118 mL 7.5% povidone iodine and 1,000 mL normal saline were combined in a basin to make a dilute betadine solution in which the foot was soaked and scrubbed from the plantar aspect to the malleoli for 3 minutes. This was followed by the standard skin antiseptic preparation for foot and ankle procedures, which consists of alcohol and chlorhexidine.
The control group received the standard alcohol and chlorhexidine skin preparation alone.
Investigators took culture swabs from the hallux nailfold in both groups right before the skin incision was made to check for positive bacterial growth rates.
“We thought patients would have a lower rate of positive bacterial skin cultures with the extra steps,” Mehraban said.
Furthermore, one of the study authors thought there might be a synergistic effect from the added extra betadine soak and scrub, she said.
According to the abstract, however, results showed there was no difference in the bacterial growth rate between the intervention group (27.6%) and the control group (26.9%).
“We found no statistical significance, and they did have one extra patient in the intervention group,” Mehraban said.
One thing that potential future studies could do is look at the inherent bacteria present prior to preoperative sterilization, she said. “Maybe what we are seeing are bacteria that never got killed.”
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Mehraban N, et al. Foot Ankle Int. 2020;doi:10.1177/1071100720925480.
Mehraban N, et al. Foot Ankle Int. 2021;doi:10.1177/10711007211025263.
Mehraban N, et al. Paper 225. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31-Sept. 3, 2021; San Diego.
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