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To The Editor: I am writing to point out two limitations not mentioned in the study presented in your article, "Efficacy of Surgical Preparation Solutions in Foot and Ankle Surgery" (2005;87: 980-5 ), by Ostrander et al. No neutralizing ingredient(s) (neutralizer) was used in the sampling method, either on the swab or in the transport or culture media. American Society for Testing and Materials (ASTM) method E1054-02 recommends adding appropriate neutralizers to the solution used for sampling skin. A neutralizer inactivates an antimicrobial at sampling so that there is no further kill in the test tube while the sample is waiting to be diluted and plated for quantification. If a neutralizer is not present, the antimicrobial will continue to kill bacteria in vitro, resulting in an erroneous higher kill rate. The lack of a neutralizer would inflate the efficacy of the water-soluble preparations (Techni-Care and ChloraPrep) tested. The second limitation is the sampling method. 3M DuraPrep Surgical Solution forms a water-insoluble film when it dries. Sampling solution with or without neutralizer will not dissolve the DuraPrep film to allow sampling of the skin beneath. Since the other antimicrobials are water-soluble, the sampling method is not consistent between products.
Journal of Bone and Joint Surgery – Wolters Kluwer Health
Published: May 1, 2006
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