Study recommends against polyhexanide wound irrigation during open abdominal surgery

Editor's Note

Although intraoperative wound irrigation is a common practice worldwide for preventing surgical site infections, a recent study suggests irrigation with polyhexanide solution should not be recommended as standard clinical practice in open clean-contaminated surgical procedures. Published February 21 in Jama Surgery, the study cautions that additional trials are warranted to evaluate the potential benefit in emergency settings and other contaminated and septic procedures.

Postoperative surgical site infection is the most common type of hospital-acquired infection across all income and development settings after gastrointestinal surgery, the researchers note, adding that the infections can prolong hospital stays and increase costs as well as morbidity and mortality rates. Given that patient-related risk factors—age, obesity, etc.—cannot be changed, research has focused on using sterile techniques such as irrigation as prevention measures.

Due to mixed results related to prophylactic polyhexanide, a relatively new solution, the multicenter Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial aimed to determine whether intraoperative wound irrigation with polyhexanide is effective in surgical site infection reduction within 30 days after open gastrointestinal surgery compared to saline or no irrigation.

The multicenter randomized clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. It included 689 adult patients undergoing laparotomy. Participants were randomized to either wound irrigation with polyhexanide, saline, or no irrigation. The incidence of surgical site infection 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation.