Antiseptic use in the prevention of pin site infection

Abstract

External fixation is commonly used in Orthopaedics to treat complicated fractures and sometimes employed in elective surgery. It consists of a series of metal pins and wires which are inserted into the bone fragments through the skin and held together by an external framework (Lethaby, Temple & Santy, 2008). The areas where these pins protrude are known as pin sites and infection at these sites is the technique's primary complication. Pin site care, a term commonly used that includes multiple nursing interventions, is highly debated as there is no evidence based standard of care. The aim of this dissertation is to challenge one aspect of such care - whether antiseptic use is necessary to reduce the incidence of pin site infections. Research question: 'In patients with external fixators do antiseptic agents reduce the incidence of pin site infection when compared to non-antiseptic products?' Methods used: A search strategy was conducted from ten electronic data bases accessible from the University of Malta website. The search was extended by manually searching an Orthopaedic journal and also in Google scholar. Those studies which compared antiseptic use against other solutions or no care at all in the cleansing/dressing aspect of pin site care were included. Out of 1175 citations, five RCTs and one prospective study were chosen. For their critical analysis, the Critical Appraisal Skills Programme (CASP) was used. Overall findings: The six studies did not reach a common conclusion. Only two out of the six studies declared that antiseptic use significantly reduces the incidence of pin site infections. Recommendations and implications for practice: The use of antiseptic solutions did not prove to be a determining factor in pin site care in the majority of the studies, although this aspect is highly controversial. It emerged that several considerations need to be taken when dealing with pin site care such as the type and width of pins, the anatomical position of the pins and the duration of the device in situ. It could be that there is no 'one size fits all' protocol. One issue in which there was unanimous agreement was observation. However due to the lack of a uniformly accepted definition of pin site infection comparisons are difficult. There is the need for a standard infection criteria classification system with proven reliability in order to have homogenous infection criteria.