Irrigation irrigation techniques used during surgery are commonly used to:

• Reduce contamination by removing particles and bacteria
• Remove nonviable tissue
• Expose healthy tissue
• Wound irrigation with antiseptic solutions has been shown to be effective for prevention of SSI.

Surgeon Tools/Recommendations:

Ways to irrigate a wound during surgery:

• Pulsatile lavage (high and low pressure)
• bulb-syringe lavage

Types of Irrigation solutions:

• detergents
• antibiotic laden lavage
• antiseptic agents
• sterile normal saline

Sterile dilute povidone-iodine (betadine): Some evidence suggests that betadine is the optimal solution for reducing bacteria while maintaining healthy tissue.

• Before closure of the wound, irrigation with sterile dilute betadine (0.35%) has been shown to decrease risk of SSI in joint replacement and spine procedures with no adverse reported outcomes.
• CDC identified as a method of SSI prevention on during lower extremity arthroplasty procedure.
• There are other intraoperative irrigation and wound lavage systems currently being utilized and researched for efficacy of SSI prevention, including 0.05% chlorhexidine gluconate as well as various solvents, pH modifiers and surfactant combinations.

Pulse Lavage: Different types of pulse lavage systems with varying pressure settings, important to consider specific pulse lavage systems and the pressure setting available.

• higher-pressure settings can potentially damage healthy or viable tissue.
• potential spread of bacteria especially in the setting of grossly contaminated wounds.