The Use of Anti-Septic Solutions in the Prevention of Neurosurgical Site
Infections

Abstract Object: Pre-incisional skin preparation with an antiseptic solution is crucial in preventing SSI. However, a lack of consensus in both general and spine surgery regarding the preference of skin preparation methods continues. The goal of this study is to evaluate the preferred method of pre-operative skin preparation for spine surgery in various academic and non-academic institutions in the United States.

Methods: The study data were generated from a telephone survey that emphasized the type of preoperative antiseptic solution used in spinal surgery. The options were: Betadine (povidone-iodine), DuraPrep (iodine-povacrylex and isopropyl alcohol), ChloraPrep (2% chlorhexidine and 70% isopropyl alcohol), and any possible combinations. A total of 128 neurosurgical departments across the United States were contacted, including all 98 ACGME accredited neurosurgical programs. Results were reported on the basis of type antiseptic solution used by each institution and by geographical region based on United States census regional distribution.

Results: Most of the neurosurgical centers used DuraPrep followed by ChloraPrep and then Betadine. Thirtyseven centers used various combinations either as a preference in isolated cases or as a combination. The surveyed neurosurgical departments came from all 9 regions in the United States (Pacific, Mountain, West south central, West north central, East north central, East south central, South Atlantic, Middle Atlantic, and New England. ChloraPrep is the preferred choice in 5 regions, whereas DuraPrep is preferred in the other 3 regions.

Conclusions: Although most of the literature is in favor of ChloraPrep over Betadine or DuraPrep in reducing SSI, the majority of neurosurgical departments continue to use iodine solutions in spine procedures.