CIPHUR

Chlorhexidine vs Iodine Prep in Hand SURgery

There is clinical uncertainty about whether Povidone-Iodine or Chlorhexidine based solutions should be used for skin prep prior to upper extremity surgery.

Alcoholic chlorhexidine is the most efficacious prep for reducing risk of surgical site infection in dirty, contaminated and clean-contaminated surgery but this is not immediately applicable to (clean) hand surgery.

Also, there are safety concerns over alcoholic and chlorhexidine preps in tourniquet-controlled upper limb surgery which warrants further investigation.

Question

The CIPHUR study aims to answer the question
“Which antiseptic skin prep is ideal for patient undergoing upper extremity surgery?”

Project Outline

  • Systematic review

    Systematic review and network meta-analysis of antiseptics in clean surgery (pending publication)

  • National survey

    National survey of clinical practice and clinician opinion (pending publication)

  • National service evaluation

    National service evaluation of patients undergoing upper limb surgery (underway)

  • Funding

    Application to NIHR RfPB/HTA (estimated 2021)

  • Multicentre study

    Definitive multicentre study (dependent on funding, 2022)

How can I get involved?

We are running a prospective audit of skin antiseptics in upper limb surgery.

Audit just 20 cases (trauma or elective) to gain co-authorship on the publication(s).

Register your interest here

Responsibilities of a collaborator

You will need to:

  • Gain support from your department (e.g. consultant body).
  • Collect data on 20 consecutive patients (adults or children) undergoing any form of upper limb surgery distal to the shoulder joint and follow-up them up for 3 months. More information will br provided to collaborators.
  • Upload anonymised information to our REDCap database

NB – Contributing data with a high missing data rate will result in an acknowledgement and certificate rather than co-authorship.

Benefits

  • Certificate of involvement will be provided on completion of the project.
  • Co-authorship on the publication(s) directly attributable to the collected data.
  • Cited as a collaborator on any presentation(s) relating to these data.
  • Option to present local data separately (i.e. local or regional meeting).

Units involved

Status
  • Systematic review and network meta-analysis
  • National service evaluation
  • Protocol development
  • PPI for definitive trial
  • NIHR RfPB application
  • CIPHUR RCT
Mr. Ryckie Wade
NIHR Doctoral Research Fellow
University of Leeds



Dr. Gordon McCauley
Foundation Doctor
Leeds Teaching Hospitals



Mr. Matthew Gardiner
Surgical Specialty Lead for Plastic Surgery, Royal College of Surgeons of England
Consultant Hand and Plastic Surgeon at Frimley Health NHS Foundation Trust. Hon Departmental Clinical Lecturer, Oxford.



Mr. Justin Wormald
Specialty Registrar in Plastic Surgery, Oxford
NIHR Academic Clinical Fellow, Oxford



Miss Grainne Bourke
Associate Professor of Plastic Surgery
Leeds Teaching Hospitals
Dr. Nicholas Burr
Leeds Teaching Hospitals

Mr. Suddhajit Sen FRCS
Associate Specialist in Trauma & Orthopaedics
Noble’s Hospital, Isle of Man

Mr. Shehan Hettiaratchy
Lead Surgeon and Major Trauma Director
Imperial College Healthcare NHS Trust
Honorary Clinical Senior Lecturer, Imperial College
Clinical Lead, Veterans Trauma Network, NHS England

Mr. Ravi Mallina
Hand Fellow
Pulvertaft Hand Unit, Derby

Mr. Graham Cheung
Consultant and Honorary Senior Lecturer in Trauma and Orthopaedics
Upper limb subspecialty lead for the North West Coast

Mr. Howard Chu
Clinical Fellow Plastic Surgery
Southmead Hospital, Bristol

We thank Darren Naughton from DazzleInk (@Dazzleink@outlook.com) for designing the artwork for this project.

Downloads
Study protocol

REDCap variables
Contact
ciphur.rstn@gmail.com