The role of skin antisepsis in upper extremity surgery to reduce surgical site infection: a comparison between single and triple regimen

Purpose: No consensus is made for preoperative skin antisepsis for upper extremity surgery. We aimed to determine if the use of povidone-iodine only (single regimen) instead of povidone-iodine and alcohol-chlorhexidine (triple regimen) resulted in an increased rate of surgical site infection (SSI), and to detect any associated factors that increased the infection risk.Methods: A cross-sectional, retrospective review of medical records was made for patients who underwent upper extremity surgery from March 2020 and February 2021. Either single or triple regimen was used for preoperative skin antisepsis. Rate of SSI was compared through marked elevation of C-reactive protein (CRP) at 2 weeks after surgery, superficial SSI, and deep SSI. Logistic regression analysis was performed to find the associated factors for the SSI among the evaluated parameters.Results: Among 175 patients (male, 81 and female, 94), single regimen was used in 78 patients (44.6%) and triple regimen in 97 patients (55.4%). Single regimen (odds ratio [OR], 2.425; 95% confidence interval [CI], 1.040–5.655) and surgical procedure using metal implant (OR, 3.602; 95% CI, 1.184–10.953) were significantly associated with the marked CRP elevation at 2 weeks. However, there was no difference in SSI rates between single and triple regimen. Diabetes mellitus (OR, 6.636; 95% CI, 1.259–34.969) was the only associating factor with superficial SSI through logistic regression analysis.Conclusion: Our study suggests that single regimen maintained a longer CRP elevation compared to the triple regimen, but was similarly effective in preventing SSI for upper extremity surgeries.