Significant reduction in incidence of wound contamination by skin flora through use of microbial sealant.

Objective: Application of skin sealant prior to incision reduces microbial contamination of the wound.

Methods: Prospective, randomized, multicenter clinical trial. Methods: Six teaching hospitals. Methods: A total of 177 adult patients undergoing elective open inguinal hernia repair were randomized to either standard skin preparation with 10% povidone-iodine or skin preparation followed by cyanoacrylate-based liquid microbial sealant. Methods: Wound contamination was assessed during surgery by microbial sampling inside the wound at initiation of skin incision and prior to skin closure. Methods: The primary outcome measures were the safety and effectiveness of cyanoacrylate-based microbial sealant to reduce bacterial contamination during surgery. The secondary outcome measure was reduction of postoperative surgical site infections using microbial sealant.

Results: Demographics were similar. Patients treated with sealant were more likely to have no bacterial cells found in the wound than control participants (47% vs 31%; P = .04). Three patients developed surgical site infections; all were in the control group (P = .25). Independent factors that reduced wound contamination were use of microbial sealant (odds ratio, 0.45; confidence interval, 0.23-0.88; P = .02) and perioperative antibiotics (odds ratio, 0.24; confidence interval, 0.10-0.58; P = .001).

Conclusions: Cyanoacrylate-based microbial sealant may be an important tool to reduce wound contamination and potentially prevent surgical site infections.