Comparison of three preoperative skin preparation techniques in ponies

The purpose of this study was to evaluate the efficacy of 3 preoperative skin preparations (povidone-iodine [PI] removed with 70% isopropanol, and 4% chlorhexidine gluconate [CG] removed with either 70% isopropanol [CA] or sterile saline solution [CS]) in ponies. Eighteen ponies were randomly assigned to one of the 3 preoperative skin preparation groups. The skin of ponies was aseptically prepared with PI removed with alcohol, or 4% CG removed with either alcohol or sterile saline solution. The antimicrobial efficacy of each skin preparation technique was assessed quantitatively by culturing for surface bacteria with replicating organism detection and counting plates. The percentage of negative cultures, the percentage of cultures with >5 colony forming units (CFU) and the percentage bacterial reduction after the cleansing scrub, the sterile scrub, and the surgical procedures were compared. There was a significant difference between CG and PI in percentage bacterial reduction after the cleansing scrub, but no significant difference at any other time (sterile scrub, post operative skin sampling). In a comparison of the number of negative microbial cultures at each sampling point, there were no significant differences among the 3 skin preparation techniques. There were no significant differences among the treatment groups comparing the number of cultures with a high colony count (>5 CFU) after the cleansing scrub. Skin preparation with CS and PI resulted in significantly fewer cultures with >5 CFU after the sterile scrub than CA. Post operatively, CA had a higher number of samples with >5 CFU than CS and PI. PI removed with alcohol and 4% CS are equally effective in the reduction of skin bacteria after a sterile skin scrub in the operating room; however, CG was more effective in reducing bacterial numbers after the cleansing scrub. The number of cultures with high bacterial counts was greater post operatively, when alcohol was used as a rinse with chlorhexidine. In cases where a sterile scrub is not performed following a cleansing scrub, CG may be a better choice than PI. CA should not be used as a presurgical skin preparation method in ponies.