Tuesday, June 17, 2014

Historical Contribution: 1925, Scott & Hill, Preoperative Skin Disinfectant


Scott WW, Hill JH. Presentation of a Preoperative Skin Disinfectant - An Alcohol-Acetone-Aqueous Solution of Mercurichrome. J Urol 1925;14:2:135-52. 

The importance of skin disinfectants were noted at the time of Halsted in the late 1800's as Johns Hopkins Hospital was opened.  In the early 1900's, most skin disinfectants were caustic, or at least irritating, to the skin and caused significant discomfort to an awake or unanesthetized patient.  This was extremely important to the urologist, who required preparation of the sensitive genital skin prior to instrumentation.

Dr. Scott describes the ideal skin disinfectant for urological procedures:

  • painless
  • high germicidal action
  • deep penetration
  • easily applied (previous methods were too time consuming or involved)
  • drying time does not sufficiently delay surgery
  • must dissolve skin debris, secretions and excretions where bacteria reside
  • low toxicity to normal tissues
    • cannot affect wound healing
  • must be colored to quickly assess the extent of the operative field
Dr. Scott then describes the process by which they arrived at a combination of mercurochrome (see prior blog entry), alcohol and acetone (MAA) that met the above criteria.  A number of bacterial species (staphylococcus, E.coli and proteus) were tested in vitro, on rabbits and finally normal, human skin.  The combination of MAA outperformed other, widely available and used antiseptics of the time (Table 3, below).  

Dr. Scott then reports the outcomes of the use of the MAA over a two month period at the Brady Urological Institute.  Over the observed time period, only one skin infection was noted - in a patient with an infected subcutaneous hematoma.  Importantly, no patient complained of dermatitis or pain with application of MAA.

This is a fascinating look at the status of surgical site infections and methods to improve outcomes in 1925.  Dr. Scott defines the important characteristics of a good skin antiseptic and then successfully experiments until he finds the mixture that meets the needs of the physicians and patients (and successfully checks off all the characteristics of the "ideal" disinfectant he sought to discover).  It is interesting that surgical site infections remain an important metric for patient-centered outcomes nearly 100 years after this paper.

To read the entire manuscript click on the link above or click here.

HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy!