Comparison of the Rapid Bactericidal Efficacy of Commercially Available Surgical Solutions

1. Introduction

Intraoperative irrigation is a commonly used method aimed at reducing microbial burden by removing tissue debris, metabolic waste, and tissue exudate from the surgical field prior to site closure.¹ With the absence of universally established standard of care and robust clinical data, the selection of appropriate irrigation solution remains a topic of debate. Isotonic saline has long been considered a safe and cost- effective irrigation solution and is most broadly used. Besides saline, the only other irrigation solution currently supported by the American Academy of Orthopaedic Surgeons, the Centers for Disease Control and Prevention, and World Health Organization is povidone-iodine.^2-3

Reported here is a comparative assessment of the in vitro rapid bactericidal efficacy of a panel of nine commercially available irrigation solutions using short (60 seconds) contact time. The study was performed using two representative species of bacteria – Gram-positive methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative Pseudomonas aeruginosa. The irrigation solutions evaluated in the study involved an array of antimicrobial technologies and preservatives, including acids, surfactants, chlorhexidine gluconate (CHG), benzalkonium chloride (BZK), polyhexamethylene biguanide (PHMB) alone and in synergy with other additives, and povidone iodine (PI).