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Spinal surgery carries a risk of surgical wound infections (i.e., the entry of bacteria). Despite various preventive measures, such infections continue to occur, particularly in operations involving implants. In this study, we would like to investigate whether rinsing the surgical wound with a special irrigation solution called PREVENTIA® can reduce the number of bacteria in the wound during the operation.
Surgical wound infections are among the possible complications following spinal surgery. There is a particularly increased risk of such infections in operations in which implants, such as screws or rods to stabilize the spine, are used. One reason for these infections is that many different bacteria live on human skin. These are found not only on the surface of the skin, but also in deeper layers of the skin, for example in hair follicles and sebaceous glands. In these areas, they cannot always be fully reached by conventional disinfectants before surgery. As a result, bacteria can enter the surgical site despite careful preparation. This study investigates a special irrigation solution called PREVENTIA®. It contains active substances, polyhexanide and poloxamer, which can kill bacteria and attack so-called biofilms. A biofilm is a type of protective layer that bacteria form on implants. Within this layer, the bacteria are better protected and can cause infections that are more difficult to treat. Until now, this solution has mainly been used for irrigating superficial wounds. However, it has not yet been investigated whether irrigating deeper tissue layers during spinal surgery can reduce the presence of bacteria. This study therefore aims to investigate: whether irrigating the surgical wound with PREVENTIA® results in fewer detectable bacteria in the surgical site, and whether this method may potentially help to reduce infections in the surgical site.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Preventia Surgical Solution | Experimental | PREVENTIA® Surgical Irrigation is a CE-marked solution containing 0.1% polyhexanide (PHMB) and poloxamer, with proven antimicrobial and anti-biofilm activity. |
|
| 0.9% NaCl Solution | Sham Comparator | Irrigation solution without intrinsic antimicrobial properties |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Preventia Surgical Solution | Device | Irrigation of the surgical wound with 0.1% polyhexanide and poloxamer and instillation for 1 minute instilled with the amount needed to fill up to the wound border before and after placement of the pedicle screws and before opening of the spinal canal (to guarantee no contact with the dura mater). This procedure is followed by complete aspiration of the fluid. |
| Measure | Description | Time Frame |
|---|---|---|
| Presence of bacterial growth | Presence of bacterial growth in at least one of four intraoperative swabs (deep wound swab 1 or 2, retractor swab, or surgical glove swab) obtained around the surgical incision site. | Assessed 14 days postoperatively. |
| Measure | Description | Time Frame |
|---|---|---|
| Presence of bacterial growth | Presence of bacterial growth in each of the four individual swabs obtained around the surgical incision site. | Assessed 14 days postoperatively. |
| bacterial species and load |
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Inclusion Criteria:
Exclusion Criteria:
Current local infection (or active treatment) involving the spine or adjacent soft tissues (e.g. spondylodiscitis, epidural or paravertebral abscess, cellulitis at the intervention site) diagnosed clinically or by imaging prior to intervention; Active systemic bacterial/fungal infection requiring antimicrobial therapy
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rami Sommerstein, Prof. Dr. Med. | Contact | +41 41 208 32 54 | rami.sommerstein@unilu.ch |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hirslanden Klinik St. Anna | Lucerne | 6006 | Switzerland |
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Single-center, open-label, randomized controlled study
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|
| 0.9 % NaCl | Device | Irrigation of the surgical wound with 0.9% NaCl and instillation for 1 minute instilled with the amount needed to fill up to the wound border before and after placement of the pedicle screws and before opening of the spinal canal (to guarantee no contact with the dura mater). This procedure is followed by complete aspiration of the fluid. |
|
Semi-quantitative assessment of bacterial species and load, reported on an ordinal scale, for each of the four individual swabs
| Assessed 14 days postoperatively |
| Surgical Site Infections | Wound healing assessment using the ASEPSIS wound scoring system. ASEPSIS stands for:
Minimum Value: 0 Maximum Value: 70 Outcome: Higher scores mean a worse outcome (greater infection severity) | on postoperative days 3-5 and for a substudy at 90 days (±15 days) and 12 months (±2 months) post-surgery |
| ID | Term |
|---|---|
| D013530 | Surgical Wound Infection |
| ID | Term |
|---|---|
| D014946 | Wound Infection |
| D007239 | Infections |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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