Intraoperative Risk Factors

Intraoperative Irrigation

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.