Visibility of Site Marking for Surgical Time Out With Two Different Skin Preparation Solutions
Status:
Completed
Trial end date:
2009-08-01
Target enrollment:
Participant gender:
Summary
Skin preparation solutions are used to clean the skin of the patient before surgery to
decrease the rate of infection. This is particularly important for hip replacement to reduce
the risk of prosthetic joint infection. The use of a mark on the skin for site identification
has become the standard of care to decrease wrong site surgery. The Joint Commission has
mandated site identification as part of the surgical "time-out". This procedure is also
mandated by hospital policy.
Preliminary work on cadaveric skin shows that the type of skin preparation can erase the mark
used for surgical site identification. Erasure of the mark presents the surgeon with
difficulty in performing the site identification. Any error or lack of visualization of the
site marking could lead to catastrophic wrong site surgery.
The investigators hypothesis is that chlorhexidine based skin preparation solutions erase
site marking in comparison to iodine based skin preparation solutions. The investigators
intend to prospectively study twenty patients undergoing total hip arthroplasty. Patients
will be randomized to either a chlorhexidine based or an iodine based skin preparation
solution. These solutions are both the current gold standard of clinical care. No differences
have been shown in infection rates for total hip arthroplasty between these solutions. The
site marking will be performed by the same surgeon in a standardized manner. The site marking
will include the surgeon's three initials as per usual routine. Underneath the initials three
random initials will be placed with a horizontal line drawn underneath. The preparation of
the skin will be performed according to the manufacturer's specifications. Digital
photographs will be taken of the skin marking after skin preparation. Photographs of the
three random initials will be de-identified and placed in a "Powerpoint" presentation form.
Ten orthopaedic surgeons will then read the site markings to identify the random initials and
to tell whether the mark looks appropriate to perform a surgical timeout. The horizontal line
will be digitally analyzed using Adobe Photoshop to quantitatively measure blackness of the
mark.