Antiseptic may reduce time prior to penile implant surgery

April 1, 2008

Chicago-A preoperative skin preparation product may be an effective, time-saving alternative for reducing skin bacterial counts preoperatively in men undergoing penile prosthesis surgery, say the authors of a pilot study from the University of South Florida, Tampa.

The product, ChloraPrep (Enturia, Inc., Leawood, KS), is a broad-spectrum antiseptic agent that contains 2% chlorhexidine gluconate and 70% isopropyl alcohol. It acts rapidly and has been used in the skin preparation protocol for other non-urologic surgeries as a 3-minute scrub.

In the study, a 3-minute scrub with this product was as effective as 10-minute scrubs with povidone-iodine (Betadine) or chlorhexidine gluconate 4% (Hibiclens) for reducing skin bacterial colonization, reported Omar Hamoui, MD, a urology resident at the University of South Florida working with Rafael E. Carrion, MD.

"Ours is just a pilot study with a small sample size; however, larger studies are warranted to confirm these results because use of ChloraPrep would offer a clear advantage for reducing time spent in the OR."

The study was conducted as follow-up to research presented at the 2006 SMSNA meeting in which povidone-iodine and chlorhexidine gluconate were shown to be equally effective for skin preparation in penile prosthesis surgery patients when each product was used in a 10-minute scrub. In the current study, 60 men were randomized equally to undergo skin preparation with povidone-iodine for 10 minutes, chlorhexidine gluconate for 10 minutes, or chlorhexidine gluconate-isopropyl alcohol for 3 minutes. Specimens were plated for aerobic and anaerobic culture, using skin swabs taken from the penile-scrotal junction immediately after the surgical site had been shaved and again after the antiseptic treatment.

"Betadine has been the standard for skin preparation in implant patients, so in our initial research, we wanted to see how it compared with Hibiclens," said Dr. Carrion, assistant professor of surgery and urology at the University of South Florida. "ChloraPrep has not been widely used in urological surgery, but it has been described as very effective for reducing skin colony counts in the general surgery literature, and especially for use in procedures involving large abdominal incisions."

Comparable results

All cultures were evaluated after a 5-day incubation period. Results from the specimens obtained prior to skin preparation showed culture positive rates of 90% for men in the chlorhexidine gluconate and povidone-iodine groups and 60% in the chlorhexidine gluconate-isopropyl alcohol group. Staphyloccocus epidermidis was the most common isolate in the pre-preparation cultures. Post-skin preparation cultures among all three treatment groups were negative for bacterial growth.

Based on a comment from the audience questioning why the pre-preparation skin culture rates were not consistently 100% across the three groups, Dr. Hamoui acknowledged that further studies to establish a viable role for chlorhexidine gluconate-isopropyl alcohol in surgical practice will require careful attention to the methodology to ensure that the culture results obtained are accurate. He noted that urologists at his institution perform a relatively high volume of penile prosthesis procedures; thus, it is hoped that a study with a larger population can be undertaken in the future.

In response to a question about cost, Dr. Hamoui responded that a cost analysis has not been undertaken; however, he suggested the prices of the three skin preparation products are similar. ChloraPrep may be slightly more expensive than the other products, but the difference in cost is minimal and conceivably would be well offset by reduced OR use and the associated cost savings, Dr. Hamoui said.