Residual bacterial contamination after surgical preparation of the foot or ankle with or without alcohol

To investigate the usefulness of a standard surgical preparation in prevention of surgical site contamination, 49 consecutive patients undergoing foot or ankle surgery were randomly assigned to standard preparation with chlorhexidine gluconate home scrubs and preoperative povidone-iodine or to standard preparation plus preoperative preparation with 70% alcohol. Results were available for all 49 patients. Cultures were positive for normal aerobic bacteria from the toes of nine of 26 patients (35%) receiving standard surgical preparation and from the toes of 13 of 23 patients (57%) receiving standard preparation plus alcohol (P=0.12). No patient had a positive culture for anaerobic organisms or clinical evidence of infection or wound problems. Standard surgical preparation did not provide a completely sterile field, and the inclusion of alcohol added no benefit.