Analysis of a ten step protocol to decrease postoperative spinal wound infections

Table 3 Clinical orthopedic studies evaluating surgical wound irrigation before closure

Ref.	Study design (level of evidence)	Surgery performed	Groups	Main outcome	Significance
Yazdi et al[64] (2014)	Prospective randomized controlled trial (I)	Arthroscopic ACL reconstruction	Irrigation with 0.9% normal saline and 80 mg/L gentamicin (n = 180), Irrigation with 0.9% normal saline (n = 180)	One infection in gentamicin group (0.57%), Four infections in normal saline alone group (2.2%)	Decreased rate of infection when using gentamicin in irrigating solution (P = 0.4)
Brown et al[65] (2012)	Retrospective cohort (IV)	Primary total hip or total knee arthroplasty	Soak wound with 500 mL 0.35% povidone-iodine followed by 1 L NS pulse lavage prior to closure (n = 688), Pulse lavage with 1 L NS only prior to closure (n = 1862)	One infection in betadine group (0.15%), Eighteen infections in saline alone group (0.97%)	Significant decrease in 90-d infection rate when soaking surgical wound with betadine solution prior to closure (P = 0.04)
Chang et al[66] (2006)	Prospective randomized controlled trial (I)	Instrumented lumbosacral posterolateral fusion for degenerative spinal disorder with segmental instability	Wounds irrigated with 0.35% povidone-iodine (n = 120), Wounds irrigated with normal saline (n = 124)	No infections in povidone-iodine group, 4.8% infection rate in saline group	Overall infection rate was statistically significant when comparing betadine solution group with no betadine group (P = 0.029)
Cheng et al[67] (2005)	Prospective randomized controlled trial (I)	Spinal decompression with or without fusion	Wounds irrigated with 0.35% povidone-iodine (n = 208), Wounds irrigated with normal saline (n = 206)	No infections in povidone-iodine group, 3.5% infection rate in saline group	Overall infection rate was statistically significant when comparing betadine solution group with no betadine group (P = 0.007)

ACL: Anterior cruciate ligament.