Microbial sealing: a new approach to reducing contamination

SummaryMost surgical site infections (SSIs) are caused by the patient's endogenous flora, and hence strategies to prevent bacterial contamination of the surgical incision have a central role in the prevention of such infections. However, even with optimal skin preparation, true sterilisation of the skin is not possible. A recently available method of preventing infection is a cyanoacrylate-based microbial sealant (marketed as InteguSeal* Microbial Sealant), which mechanically blocks migration of pathogens to the surgical wound. In in-vitro studies, this preoperative preparation reduced the recovery of pathogens commonly implicated in SSIs by up to 99.9%. Similarly, the incidence of wound contamination was lower with the microbial sealant than with antimicrobial surgical drapes in in-vivo studies. Other studies have shown that this microbial sealant significantly improves the effect of povidone iodine by fixing it on the skin and avoiding wash off, and does not affect normal skin transpiration. In a clinical study in 177 patients, the incidence of wound contamination was 53.0% with the sealant, compared with 68.7% using povidone iodine. The conclusion of this clinical study is that InteguSeal* Microbial Sealant significantly reduces surgical wound bacterial contamination when used in conjunction with 10% povidone iodine skin preparation, as compared to povidone iodine alone. The clinical experience to date is that this sealant is easy to apply and can be used with a variety of skin preparation solutions and with most wound closure techniques. It also has a good safety profile. This preparation may therefore form a valuable part of strategies to reduce bacterial contamination of surgical incisions, thereby potentially decreasing the risk of SSIs.