At least 5% of patients undergoing a surgical procedure will go on to develop a surgical site infection1. These infections can lengthen a patient’s stay, increase costs, and even be deadly.
It is estimated that around 30% of these infections can be prevented through the application of existing knowledge and tools9. 3M™ Ioban™ Antimicrobial Incise Drapes2 are one of these tools, and one of the most underused tools in our armoury. With new evidence to demonstrating the antimicrobial activity of Ioban drapes and their role in reducing in SSI rates, now is the perfect time to incorporate their use into your surgical practice.
There is a vast array of evidence which demonstrates the negative effects of surgical site infections; from increased morbidity, cost of care and length of hospital stay, to decreased patient satisfaction scores and lower quality of life.
Evidence shows that nearly 5% of surgical patients will go on to develop an SSI1.
Since we know that the risk of acquiring a SSI is directly linked to the number of skin microbes on a patient’s skin, appropriate skin preparation before and throughout surgery is key.
The Centers for Disease Control and Prevention (CDC) state that the risk of surgical site infection (SSI) can be measured according to three distinct viariables:
The resistance of the host i.e. how good the patient's immune system is.
The dose of microbial contamination i.e. how many microbes there are.
The virulence of contaminating microbes i.e. how infectious the microbes are.
Whilst skin preps reduce microbes on the skin surface, bacteria in the deeper skin layers will remain. Over time these microbes will recolonise the skin surface. If these microbes then contaminate the surgical wound; a SSI is likely to occur.
A study from Elliott et al (2015) now demonstrates that iodine released from 3M™ Ioban™ Antimicrobial Incise Drapes2 is able to penetrate the deeper skin layers at a concentration required for microbial death11.
Incise drapes are usually sterilised using either gamma irradiation or ethylene oxide. The method used can have an impact on the chemical composition of the iodine contained within the drape.
It is well-documented that when products containing iodine come into contact with ethylene oxide, ethylene iodohydrin can be produced. This can be a skin irritant and is why 3M sterilises Ioban Incise Drapes using gamma irradiation.
J Cardiovasc Trans. Res. 2015.13
Examine the efficacy in preventing SSI in cardiac surgery, using two different drapes; an iodine impregnated drape (Ioban drape) and a non-iodine impregnated drape (standard drape). The cost effectiveness of each drape was also evaluated.
A total of 1616 patients undergoing cardiac surgery were matched in terms of risk factors. 808 patients received Ioban drapes, and the other group of 808 patients received a standard drape.
The overall costs of treating each patient group was then measured, taking into consideration the cost of drapes, antibiotic treatment, VAC therapy, sternal wound revision staff salaries and extended hospital stay.
SSI rates for the group which received the standard drape was measured to be 6.5%. In comparison the SSI rate for the group which received the Ioban drape was 1.9%; a statistically significant difference.
Results from the cost analysis demonstrated that the use of an Ioban drape offered a total cost saving of €773,495 - equivalent to €957 per patient.
To investigate the risk factors associated with surgical site infection in liver surgery, with special attention paid to the use of iodophor impregnated drapes (Ioban drapes).
A retrospective study on 296 patients undergoing liver surgery. A total of 122 patients received an Ioban drape, whilst 174 patients received no drape at all. The SSI rates across both groups was then compared.
SSI rates in the patient group who were not treated with a drape was measured at 12.1%. In contrast, the SSI rate in the patient group who were treated with an Ioban drape was 3.1%; a statistically significant difference. The author concluded “the non-use of iodophor drapes is a possible risk factor for wound infection after liver surgery”.
Ioban drapes have been used in millions of procedures worldwide for over 30 years. Its eﬀectiveness has been documented in numerous clinical studies dating from the 1980’s until the present day. No other incise drape oﬀers this level of assurance.
Clinical studies have shown that Ioban drapes are eﬀective at reducing wound contamination, surgical site infections, and most recently, cost.
In accordance with the EU Medical Device Directive, Ioban drapes are classified as a Class III medical device. This is because the iodine in the incise drape is a drug which works in the deeper layers of a patient’s skin to reduce the risk of SSI.
To be awarded a class III status, the manufacturer must present evidence to prove both the device and drug component are safe and effective.
Class II incise drapes do not offer the same level of assurance. Their drug component has not been assessed for safety of efficacy as the manufacturer submitted evidence that the drug component does not act on the human body.
1. Smyth ET et al. (2008) Four Country Healthcare Associated Infection Prevalence Survey 2006: Overview of the results. Journal of Hospital Infection; 69:230–48.
2. Plowman R, Graves N, Griffin M et al (1999) The socio-economic burden of hospital acquired infection. London: Public Health. Laboratory Service.
3. National audit office (2000). The management and control of hospital acquired infection in acute NHS trusts in England. London: The Stationery Office.
4. Elliott et al. Antimicrobial activity and skin permeation of iodine present in an iodine-impregnated surgical incise drape. J. Antimicrobial Chemotherapy. 2015.
5. Medical Device Directive 93/42 (EEC)
6. Yoshimura et al. Plastic iodophor drape during liver surgery operative use of the iodophor impregnated adhesive drape to prevent wound infection during high risk surgery. World J. Surgery. 2003; 27:685-688.
7. Rezapoor M, Tan TL, Maltenfort MG, Parvizi J. Incise draping reduces the rate of contamination of the surgical site during hip surgery: a prospective, randomized trial. J Arthroplasty. Im Druck.
8. Bejko et al. Comparison of efficacy and cost of iodine impregnated drape vs. standard in cardiac surgery: study in 5100 patients. J Cardiovasc Trans. Res. 2015; 8:431-437.