Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;6(1):34-38.

Preoperative Sterilization Preparation of the Shoulder: A Comparative Study Evaluating Gauze Sponge and Commercially Available Applicator Prep Stick

Usman Ali M Syed  1   2   3   4   5 , Adam J Seidl  1   2   3   4   5 , Ryan A Hoffman  1   2   3   4   5 , Justin Bianchini  1   2   3   4   5 , Pedro K Beredjiklian  1   2   3   4   5 , Joseph A Abboud  1   2   3   4   5
Affiliations

Preoperative Sterilization Preparation of the Shoulder: A Comparative Study Evaluating Gauze Sponge and Commercially Available Applicator Prep Stick

Usman Ali M Syed et al. Arch Bone Jt Surg. 2018 Jan.

Abstract

Background: Surgical site infection (SSI) remains a concern in shoulder surgery, especially during arthroplasty. While many studies have explored the characteristics and efficacy of different sterilizing solutions, no study has evaluated the method of application. The purpose of this study was to compare two popular pre-surgical preparatory applications (two 4 x 4 cm gauze sponges and applicator stick) in their ability to cover the skin of the shoulder.

Methods: Two orthopedic surgeons simulated the standard pre-surgical skin preparation on 22 shoulders of volunteer subjects. Each surgeon alternated between an applicator stick and two sterile 4x4 cm gauze sponges. Skin preparation was performed with a commercially available solution that can be illuminated under UV-A light. Advanced image-analysis software was utilized to determine un-prepped areas. A two-tailed paired t-test was performed to compare percentage of un-prepped skin.

Results: The applicator stick method resulted in a significantly higher percentage of un-prepped skin (27.25%, Range 10-49.3) than the gauze sponge method (15.37%, Range 5-32.8, P=0.002). Based on image evaluation, most un-prepped areas were present around the axilla.

Conclusion: Based on our findings, the use of simple gauze sponges for pre-surgical preparatory application of sterilization solution may result in a lower percent of un-prepped skin than commercially available applicator stick. Orthopaedic surgeons and operating room staff should be careful during the pre-surgical sterile preparation of the shoulder, especially the region around the axilla, in order to reduce the potential risk of surgical site infection.Level of evidence: III.

Keywords: Applicator stick; Gauze sponge; Infection; Shoulder; Sterile preparation; Surgical site infection.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Depicts our surgical preparation setting with the patient in the beach chair position with the surgeons alternating between using the prep stick and the gauze sponge.preparation setting with the patient in the beach chair position with the surgeons alternating between using the prep stick and the gauze sponge.
Figure 2
Figure 2
An example of the digital photographs before and after evaluation with the NIS-Element Advanced Research image analysis software. Notably, the region around the axilla remains largely un-prepped with the applicator stick.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Boekel P, Blackshaw R, Van Bavel D, Riazi A, Hau R. Sterile stockinette in orthopaedic surgery: a possible pathway for infection. ANZ J Surg. 2012;82(11):838–43. - PubMed
    1. Lee MJ, Pottinger PS, Butler-Wu S, Bumgarner RE, Russ SM, Matsen FA., 3rd Propionibacterium persists in the skin despite standard surgical preparation. J Bone Joint Surg Am. 2014;96(17):1447–50. - PubMed
    1. Savage JW, Weatherford BM, Sugrue PA, Nolden MT, Liu JC, Song JK, et al. Efficacy of surgical preparation solutions in lumbar spine surgery. J Bone Joint Surg Am. 2012;94(6):490–4. - PubMed
    1. Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop. 2001;382(1):206–16. - PubMed
    1. Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br. 2004;86(1):65–9. - PubMed

LinkOut - more resources