***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: HYPOTHESIS Deep infection after shoulder surgery is a rare but devastating problem . This study tested the hypothesis that the home application of a 2 % chlorhexidine gluconate cloth before shoulder surgery would be more efficacious than a st and ard shower of soap and water at decreasing the preoperative cutaneous levels of pathogenic bacteria on the shoulder . MATERIAL S AND METHODS This r and omized , prospect i ve study evaluated 100 consecutive patients undergoing shoulder surgery . Patients were r and omly assigned to use 2 % chlorhexidine gluconate-impregnated cloths ( treatment group ) or to shower with soap and water before surgery ( control group ) . Cutaneous cultures were taken from the patients ' shoulders in the preoperative holding area . Patients were monitored for 2 months postoperatively for clinical signs of infection . RESULTS In the treatment group vs the control group , the overall positive culture rate was 66 % vs 94 % ( P = .0008 ) , and the positive culture rate for coagulase-negative Staphylococcus was 30 % vs 70 % ( P = .0001 ) . The positive culture rate for Propionibacterium acnes was 46 % in the treatment group vs 58 % in the control group ( P = .32 ) . No infections occurred in any patients at a minimum of 2-months after surgery . DISCUSSION The use of the 2 % chlorhexidine cloth was effective at decreasing overall bacterial culture rates before shoulder surgery and was particularly effective at decreasing the quantity of coagulase-negative Staphylococcus , a known causative agent of postoperative shoulder infections . CONCLUSION Use of chlorhexidine impregnated cloths prior to shoulder surgery may be a useful adjunct to presently used infection prevention strategies PURPOSE We determined if the incidence of a perioperative surgical site-positive culture was reduced by a 5-day topical antimicrobial scrub before implantation of an artificial urinary sphincter . MATERIAL S AND METHODS A single surgeon prospect i ve cohort study was conducted of 100 consecutive artificial urinary sphincter implants placed between May 2003 and November 2005 . We compared 50 men who performed preoperative topical antimicrobial scrub with 4 % chlorhexidine to the abdominal site and perineal site with 50 men who used their normal hygiene ( soap and water ) . All received povidone-iodine skin disinfection before incision , and bacterial cultures of the abdominal and perineal sites were collected immediately after skin disinfection and after artificial urinary sphincter implantation . Baseline comparisons between groups were done with the Wilcoxon rank sum and Fisher exact tests . Predictors of positive culture were identified using multivariate logistic regression analysis . RESULTS The causes of incontinence were radical prostatectomy ( 90 ) , radiation therapy ( 8) and transurethral resection of the prostate ( 2 ) . There were no baseline differences between the groups including age , diabetes or previous urethral surgery . Overall 140 of the 400 cultures were positive with only 37 % of the positive cultures ( 52 of 140 ) observed with topical antimicrobial scrub . For the perineal site the only factor affecting preoperative culture status was topical antimicrobial scrub ( OR 0.23 , p = 0.003 ) . A positive postoperative culture was predicted by a positive preoperative perineal ( OR 4.61 , p = 0.003 ) and abdominal culture ( OR 3.80 , p = 0.013 ) . CONCLUSIONS Preoperative topical antimicrobial scrub result ed in a 4-fold reduction in preoperative perineal colonization rate and overall reduction in positive surgical site cultures . Given the low cost , safety and efficacy , topical antimicrobial scrub should be considered before artificial urinary sphincter placement Nurses at a large southwestern hospital undertook an initiative to optimize the preoperative skin preparation of patients undergoing open heart surgery .  After an extensive review of the literature , a proposal was su bmi tted to and accepted by the surgeons and internal review board of the hospital . High-risk patients were identified before surgery and r and omized into groups to receive one of four different skin preps . The incidence of infection was lower in the two groups of patients who were prepped with insoluble iodine , indicating that the type of surgical skin prep could affect whether patients develop surgical site infections . The clinical practice of skin preparation in this hospital changed based on the results OBJECTIVE The purpose of this study was to compare the efficacy of chlorhexidine and povidone iodine for cleansing the operative field for vaginal surgery . STUDY DESIGN This was a r and omized controlled trial that compared 10 % povidone iodine and 4 % chlorhexidine gluconate as surgical scrubs . Our primary end point was the proportion of contaminated specimens ( defined as total bacterial colony counts of > /=5000 colony-forming units ) per group found throughout the surgical procedures . All patients received st and ard infection prophylaxis  that included preoperative intravenous antibiotics . Immediately before antibiotic administration and baseline aerobic and anaerobic cultures of the vaginal flora were obtained , which were followed by cultures at 30 minutes after the surgical scrub and hourly thereafter throughout each patient 's surgery . RESULTS A total of 50 patients were enrolled between October 2002 and September 2003 . There were no differences between the povidone iodine ( n = 27 ) and chlorhexidine ( n = 23 ) groups with respect to age , race , exogenous hormone use , body mass index , gravity , parity , preoperative mean colony counts , or operative time . Among the first set of intraoperative specimens ( which were obtained 30 minutes after the surgical scrub ) , 63 % of the cultures ( 17/27 ) from the povidone iodine group and 22 % of the cultures ( 5/23 ) from the chlorhexidine group were classified as contaminated ( P = .003 ; relative risk , 6.12 ; 95 % CI , 1.7 , 21.6 ) . Subsequent cultures failed to demonstrate significant differences . CONCLUSION Chlorhexidine gluconate was more effective than povidone iodine in decreasing the bacterial colony counts that were found in the operative field for vaginal hysterectomy BACKGROUND Previous studies have demonstrated higher infection rates following orthopaedic procedures on the foot and ankle as compared with procedures involving other areas of the body . Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery . The purpose of the present study was to evaluate the efficacy of three different surgical skin-preparation solutions in eliminating potential bacterial pathogens from the foot . METHODS A prospect i ve study was undertaken to evaluate 125 consecutive patients undergoing surgery of the foot and ankle . Each lower extremity was prepared with one of three r and omly selected solutions : DuraPrep ( 0.7 % iodine and 74 % isopropyl alcohol ) , Techni-Care ( 3.0 % chloroxylenol ) , or ChloraPrep ( 2 % chlorhexidine gluconate and 70 % isopropyl alcohol ) . After preparation , quantitative culture specimens were obtained from three locations : the hallux nailfold ( the hallux site ) , the web spaces between the second and third and between the fourth and fifth digits ( the toe site ) , and the anterior part of the tibia ( the control site ) . RESULTS In the Techni-Care group , bacteria grew on culture of specimens obtained from 95 % of the hallux sites , 98 % of the toe sites , and 35 % of the control sites . In the DuraPrep group , bacteria grew on culture of specimens obtained from 65 % of the hallux sites , 45 % of the toe sites , and 23 % of the control sites . In the ChloraPrep group , bacteria grew on culture of specimens from 30 % of the hallux sites , 23 % of the toe sites , and 10 % of the control sites . ChloraPrep was the most effective agent for eliminating bacteria from the halluces and the toes ( p < 0.0001 ) . CONCLUSIONS The use of effective preoperative preparation solution is an important step in limiting surgical wound contamination and preventing infection , particularly in foot and ankle surgery . Of the three solutions tested in the present study , the combination of chlorhexidine and alcohol ( ChloraPrep ) was most effective for eliminating bacteria from the forefoot prior to surgery Background : Preoperative showering with antiseptic skin cleansers is common in elective operations , although the value of this procedure in reducing surgical wound infections has not been established . The authors design ed a prospect i ve study to assess the influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures . Methods : Patients older than 18 years scheduled for elective and clean plastic surgery procedures on the thorax or abdomen were assigned r and omly to the  povidone-iodine group ( n = 57 ) or to a  control group ( n = 57 ) . Patients allocated to the povidone-iodine group took a shower with liquid detergent – based povidone-iodine 10 % 2 hours before surgery . For the control group , no special instructions for showering were implemented before surgery . Quantitative skin cultures were obtained just before the preoperative scrub in the operating room . Sample s were plated on hypertonic mannitol agar , blood agar , Sabouraud agar with chloramphenicol , and eosin-methylene blue agar . Sample s were collected and processed , and results were assessed by blinded investigators . Results : Staphylococcal skin colonization was significantly lower in the povidone-iodine group ( p < 0.001 ) . No microorganism growth was observed on 33 percent of the postshower skin cultures from patients in the povidone-iodine shower group compared with 0 percent of the cultures from patients in the control group . Colonies of fungi and enterobacteria were recovered in small amounts in both groups , and povidone-iodine showers did not significantly reduce skin colonization by these microorganisms . Conclusion : Single preoperative povidone-iodine showers are effective in reducing staphylococcal skin colonization before elective clean plastic surgical procedures on the thorax and abdomen OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Feet are prone to bacterial contamination . We hypothesized that chlorhexidine scrub and isopropyl alcohol paint provide superior local flora reduction than povidone-iodine scrub and paint . Patients with intact , uninfected skin having clean elective foot and ankle surgery were prospect ively enrolled and r and omly assigned to skin preparation with povidone-iodine ( Group 1 ) or chlorhexidine scrub and isopropyl alcohol paint ( Group 2 ) . Culture swabs ( aerobic , anaerobic , acid fast , fungus , and routine antibiotic sensitivity ) were taken from all web spaces , nail folds , toe surfaces , and proposed surgical incision sites . One-hundred twenty-seven patients were enrolled ( mean age , 46 years ; range , 16–85 years ) . Sixty-seven patients were assigned to Group 1 ; 60 patients were assigned to Group 2 . In Group 1 , 53 of 67 patients ( 79 % ) had positive cultures ; in Group 2 , 23 of 6 
    Output:
    
The results indicated that presurgical antiseptic showering is effective for reducing skin flora and may reduce SSI rates .
The evidence suggests that preoperative antiseptic showers reduce bacterial colonization and may be effective at preventing SSIs .
The antiseptic application method is inconsequential , and data are lacking to suggest which antiseptic solution is the most effective .