Significant reduction in incidence of wound contamination by skin flora through use of microbial sealant.

HYPOTHESIS Application of skin sealant prior to incision reduces microbial contamination of the wound. DESIGN Prospective, randomized, multicenter clinical trial. SETTING Six teaching hospitals. PATIENTS A total of 177 adult patients undergoing elective open inguinal hernia repair were randomized to either standard skin preparation with 10% povidone-iodine or skin preparation followed by cyanoacrylate-based liquid microbial sealant. INTERVENTIONS Wound contamination was assessed during surgery by microbial sampling inside the wound at initiation of skin incision and prior to skin closure. MAIN OUTCOME MEASURES The primary outcome measures were the safety and effectiveness of cyanoacrylate-based microbial sealant to reduce bacterial contamination during surgery. The secondary outcome measure was reduction of postoperative surgical site infections using microbial sealant. RESULTS Demographics were similar. Patients treated with sealant were more likely to have no bacterial cells found in the wound than control participants (47% vs 31%; P = .04). Three patients developed surgical site infections; all were in the control group (P = .25). Independent factors that reduced wound contamination were use of microbial sealant (odds ratio, 0.45; confidence interval, 0.23-0.88; P = .02) and perioperative antibiotics (odds ratio, 0.24; confidence interval, 0.10-0.58; P = .001). CONCLUSION Cyanoacrylate-based microbial sealant may be an important tool to reduce wound contamination and potentially prevent surgical site infections.