Intraoperative Risk Factors
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.
Ways to irrigate a wound during surgery:
- Pulsatile lavage (high and low pressure)
- bulb-syringe lavage
Types of Irrigation solutions:
- 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.