Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis - Assignment Example

The following article is a critical examination of the comparison between Chlorhexidine and Povidone Iodine in Preoperative Skin Preparation. The variables used in this case are Chlorhexidine and Povidone Iodine as curatives or antiseptics to be used in preoperative skin operations. In this case, the researcher has identified Chlorhexidine iodine as the best preoperative surgical antiseptic as compared to provodine iodine Background The skin of the patients is a major source of pathogens, which causes surgical-site infections, and the optimization of the preoperative skin antisepsis may reduce post-operative infections. In these articles, the researcher has hypothesized that preoperative skin cleansing with chlorhexidine–alcohol is further protecting to infection than is povidone–iodine. The researcher also randomly assigned patients undertaking clean-contaminated surgery in various hospitals to preoperative skin preparation with either chlorhexidine–alcohol scrub or povidone–iodine scrub and paint (Darouiche et al., 2010). Objective The objective and aim of the research was to compare and contrast the effects of different skin preparation elucidations on surgical-site infection rates. The researcher wanted to obtain the best preoperative skin preparations before the surgery. Methodology Used In these articles, the researchers randomly conducted a clinical trial between 2004 and May 2008 at six different universities, which are affiliated to various hospitals in the United States. During the research, the researchers took a population of patients above the age of 18 years that were undergoing clean contaminated surgery. The areas of focus for the surgery were all related to the skin such as gastro esophageal conditions, thoracic conditions, or urologic surgeries done within contained conditions without substantial spillage. The research excluded patients with allergy reactions to chlorhexidine, ethanol, or iodophors (Berry et al., 1982). Tool of Data Collection In the quantitative research, the patients were separated in a 1:1 ratio in order to have their skin either preoperatively cleaned with an applicator which had 2% chlorhexidine gluconate in addition 70% isopropyl alcohol. Other patients were scrubbed using aqueous solution of 10% povidone–iodine. Moreover, in this research, a supplementary chlorhexidine–alcohol applicator was used if the area covered surpassed 33 by 33 cm. the area covered was in line with the two groups and addressed potential interhospital differences. The research involved randomly stratifying the hospitals using computer generated randomization numbers without blocking. In this research however, there is no mention of reliability and or validity of the data meaning that the data might have been altered. This also means that the data is not reliable for future research. A rationale of 1: 1 is given for the as a choice of tool for separating the two groups. An alternative tool could have been used to generate the data obtained other than using an independent researcher who did not take part in collection the data. Moreover, the computer-generated statistics did not take into consideration very many factors that affected the whole process of the research. Such factors include the individuals responses to allergy caused the scrubs with Chlorhexidine and Povidone Iodine in Preoperative Skin Preparation. However, in the research, the data obtained was biased since (Larson & Elaine, 2012) In this research, the method of processing and analyzing the data in the research differs in the one described in the methodology section from the one described in the data analysis and presentation section. According to the methodology section, one of the authors who are a statisian completely analyzed the data while in the data analysis and presentation section a computer was used to analyze and present a computer generated randomization numbers without blocking. However, the researcher has clearly explained the statistical techniques and methods of presentation of the data. The researcher uses tables, graphs, and pie charts to present the data. Sample The results of the research are based on 849 people who were divided into two different groups. One of the groups is composed of 409 people who use chlorhexidine–alcohol to treat themselves before the surgery while other comprised of 440 who used povidone–iodine to treat themselves before the surgery. This sample was derived to represent a population of 300,000 to 500,000 patients who undergo surgery in the United States each year. However, this sample did not take into consideration the very other people who require the surgery and do not use the prescribed antiseptics. The research, as a randomized control trial was not very successful since there were some dropout cases reported or some victims developing reactions to the substances used. The dropout rate could have an effect on the result of the research since the data will not represent the whole sample. The exclusion of these people was not clearly stated in the data used to present the information. The research also failed in that the reasonable provided with the rationale and the nature of the sample. The research also limited whom the results may apply. This happened in that the research did not take into consideration those people who develop reaction before and after using either Chlorhexidine or Povidone Iodine in Preoperative Skin Preparation. The sampling strategy used in this case was a random sampling technique. This technique failed in various ways that led misrepresenting the information. One of the failures of the random sampling technique is that the criteria used in this research are not necessarily random. This is because the researcher selected the kind of people to be used while discriminating others. In this research, the researcher did not take into consideration those patients who developed allergic reactions to the use of either Chlorhexidine or Povidone Iodine in Preoperative Skin Preparation. This means that the information presented suffers a lot from bias and thus cannot be relied upon for further statistical analysis. The research was also biased in that the number of men 133 was much lower compared to women 442. The research also involved people who have different ailments where most of them were suffering from chronic underlying diseases. However, all the people involved in this case were in American Society of Anesthetics, ASA physical status groupings (Swenson et al., 2010). Ethical Considerations The research was approved by the society for healthcare epidemiology of America. The research also takes into consideration the set guidelines and principles set by the Center for Disease Control and prevention. The research gained information consent from the approved universities that are affiliated to different hospitals. However, due to the intention of the research and the high number of parties involved in the research, there was no mention of confidentiality of the information obtained. However, the research was not ethically rigorous in that it takes into consideration only the approval of The Society for Healthcare Epidemiology of America living out some important review boards such as the center for disease control and prevention. Main Findings The findings of the research show that the use of chlorhexidine is better than bathing with either povidone-iodine or medicated soap. This is because chlorhexidine reduces prescrub colony counts of bacteria on the skin overlying the incision cite than povidone-iodine. Moreover, the research shows that using both chlorhexidine shower and scrub is also better than the other treatments in averting extrinsic intraoperative wound contamination. However, the research used a small number of cases whereby the low rates of infection that are related with surgical procedures did not allow the researchers to assess differences between groups in this outcome parameter. Moreover, research was not premeditated with adequate power to associate rates of infection between the two study groups (Kinirons, Mimoz, & Olivier, 2001). Conclusion and Recommendations The research gave a clear answer to their aims and objectives. The main aim of the research was to identify the best preventive antiseptics to use before skin operations. The research came up with the answer that chlorhexidine is better than bathing with povidone-iodine. However, the research did not clearly state whether the findings of their research was in line with their stated hypothesis. The hypothesis to the research was to compare the effects of chlorhexidine bathing with povidone-iodine. However, we can clearly see that the research achieved its objective. The researchers did a good job in the way they collected their data. This is because they used a sample of a large number of patients, which would be good to determine the mean and thus prevent biasness. Moreover, the results obtained would not be affected by extreme variables due to the large sample used. The use of computer program to generate an answer in their research was a good measure to prevent the occurrence of errors in their result. However, various errors occurred in the process of the research. One of them is the criteria in which they used to select their sample. The research a very small number of men as compared to that of women. In addition, the number of patients who used Chlorhexidine was few as compared to those who used povidone–iodine. This means that the results obtained would have a small variation with a bias towards Chlorhexidine. Moreover, the research did not acknowledge the limitations of the study. The results of this study can be related to practice and considerations towards a change made in order to prevent the information research from being biased (Bibbo et al., 2005). Works Cited Berry, R, B Watt, & Goldacre, J 1982, A comparison of the use of povidone-iodine and chlorhexidine in the prophylaxis of postoperative wound infection, jGnmta1 of Hospital Infection. 3(5), pp.55-63. Bibbo, C, Patel, D, & Robin G 2005, Chlorhexidine Provides Superior Skin Decontamination in Foot and Ankle Surgery: A Prospective Randomized Study. Clinical Orthopaedics & Related Research, 438(2), pp.3-56. Darouiche, R Matthew W, Kamal I, & Mary F. Otterson, 2010, Chlorhexidine–Alcohol versus Povidone–Iodine for Surgical-Site Antisepsis, The New England journal of medicine, 1(1), pp.18-24. Kinirons, B & Olivier, M 2001, Chlorhexidine versus Povidone Iodine in Preventing Colonization of Continuous Epidural Catheters in Children: A Randomized, Controlled Trial, Anesthesiology 94(2), pp. 239-244. Larson, E 2012, GuideUne for use of topical antimicro agents, Apic Guidelines For Infection Control Practice, 16(5), pp.254-270. Swenson, B, Traci, H., & Rosemarie M 2010, Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates: A Prospective Study of 3 Skin Preparation Protocols. [online]. [Accessed 1 November 2012], Available from World < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371364/> Read More