Study of the Combination of a Cyanoacrylate and Surgical Solutions in Reducing Skin Flora Contamination

• Change in Number of Unique Bacterial Isolates From Pre-skin Preparation to Post-CABG - Sternal Site [ Time Frame: Before surgery (prior to skin preparation) and after surgery (after closing fascia) ] [ Designated as safety issue: No ]
  Number of unique bacterial colony types isolated from samples of skin flora taken from the sternal incision site after surgery minus before surgery (prior to skin prep). Unique colonies were determined based on Gram stain, colony morphology, catalase, coagulase, or staphylococci latex agglutination and oxidase tests.
• Change in Number of Unique Bacterial Isolates From Pre-skin Preparation to Post-CABG - Graft Site [ Time Frame: Before surgery (prior to skin preparation) and after surgery (after closing fascia) ] [ Designated as safety issue: No ]
  Number of unique bacterial colony types isolated from samples of skin flora taken from the graft incision site after surgery minus before surgery (prior to skin prep). Unique colonies were determined based on Gram stain, colony morphology, catalase, coagulase, or staphylococci latex agglutination and oxidase tests.

• Change in Bacterial Count From Pre-skin Preparation to Post-CABG - Sternal Site [ Time Frame: Before surgery (prior to skin preparation) and after surgery (after closing fascia) ] [ Designated as safety issue: No ]
  Total bacterial counts from samples of skin flora from the sternal incision site after surgery minus before surgery (prior to skin prep).
• Change in Bacterial Count From Pre-skin Preparation to Post-CABG - Graft Site [ Time Frame: Before surgery (prior to skin preparation) and after surgery (after closing fascia) ] [ Designated as safety issue: No ]
  Total bacterial counts from samples of skin flora from the graft incision site after surgery minus before surgery (prior to skin prep).
• Post-CABG Procedure Bacterial Count - Sternal Site [ Time Frame: Post-surgery ] [ Designated as safety issue: No ]
  Total bacterial counts from samples of skin flora of the sternal incision site taken immediately following the CABG procedure.
• Post-CABG Procedure Bacterial Count - Graft Site [ Time Frame: Post-surgery ] [ Designated as safety issue: No ]
  Total bacterial counts from samples of skin flora of the graft incision site taken immediately following the CABG procedure.
• Change in the Number of Unique Bacterial Isolates From Pre-skin Preparation to Post-incision - Sternal Site [ Time Frame: Before surgery (prior to skin preparation) and immediately after incision ] [ Designated as safety issue: No ]
  Number of unique bacterial colony types isolated from samples of skin flora from the sternal incision site immediately after the incision minus before surgery (prior to surgical skin prep). Unique colonies were determined based on Gram stain, colony morphology, catalase, coagulase, or staphylococci latex agglutination and oxidase tests.
• Change in the Number of Unique Bacterial Isolates From Pre-skin Preparation to Post-incision - Graft Site [ Time Frame: Before surgery (prior to skin preparation) and immediately after incision ] [ Designated as safety issue: No ]
  Number of unique bacterial colony types isolated from samples of skin flora from the graft incision site immediately after the incision minus before surgery (prior to surgical skin prep). Unique colonies were determined based on Gram stain, colony morphology, catalase, coagulase, or staphylococci latex agglutination and oxidase tests.
• Change in Bacterial Count From Pre-skin Preparation to Post-incision - Sternal Site [ Time Frame: Before surgery (prior to skin preparation) and immediately after incision ] [ Designated as safety issue: No ]
  Total bacterial counts from samples of skin flora from the sternal incision site immediately after incision minus before surgery (prior to skin prep)
• Change in Bacterial Count From Pre-skin Preparation to Post-incision - Graft Site [ Time Frame: Before surgery (prior to skin preparation) and immediately after incision ] [ Designated as safety issue: No ]
  Total bacterial counts from samples of skin flora from the graft incision site immediately after incision minus before surgery (prior to skin prep)
• Post-incision Bacterial Count - Sternal Site [ Time Frame: Immediately after surgical incision ] [ Designated as safety issue: No ]
  Total bacterial counts from samples of skin flora of the sternal incision site taken immediately following the surgical incision
• Post-incision Bacterial Count - Graft Site [ Time Frame: Immediately after surgical incision ] [ Designated as safety issue: No ]
  Total bacterial counts from samples of skin flora of the graft incision site taken immediately following the surgical incision
• Number of Patients With SSI at the Sternal Site and/or Graft Site [ Time Frame: 30 days ] [ Designated as safety issue: Yes ]
  Number of patients who develop at least one surgical site infection at the sternal or graft site during the 30 day post-op follow-up period
• Number of Patients With Alcohol Use, Tobacco Use, or Obesity With Surgical Site Infection (SSI) [ Time Frame: 30 days ] [ Designated as safety issue: Yes ]
  Number of patients with risk factors of alcohol use, tobacco use, or obesity who developed an SSI at the sternal and/or graft site

• Compare quantitative reduction in microbial count of skin flora at the end of surgery to intact skin at the beginning of surgery between two treatment groups. [ Time Frame: 6 months ]
• Comparison of quantitative microbial counts at end of surgery between two treatment groups. [ Time Frame: 6 months ]
• Comparison of qualitative reduction in skin flora immediately post incision to intact skin flora at beginning of surgery between two treatment groups. [ Time Frame: 6 months ]
• Comparison of quantitative reduction in microbial count of skin flora immediately post-incision to intact skin flora at beginning of surgery between two treatment groups. [ Time Frame: 6 months ]
• Comparison of quantitative microbial count of skin flora immediately post-incision between two treatment groups. [ Time Frame: 6 months ]
• Evaluation of proportion of subjects with SSIs between two treatment groups. [ Time Frame: 6 months ]
• Evaluation of other factors related to SSIs. [ Time Frame: 6 months ]

The purpose of this study is to determine if there is a qualitative reduction in microbial skin flora post-surgery compared to pre-surgery when a cyanoacrylate based microbial sealant is used in combination with a surgical skin preparation solution.

The CDC states that there are two sources of surgical site infection (SSI) pathogens- endogenous and exogenous. The endogenous flora of the patient's skin, mucous membranes, or hollow viscera are the source of pathogens for most SSIs. In addition to the known sources of SSI pathogen, there are also known risk factors for SSI. The risk factors for SSIs may be patient-related, or related to the preoperative, intra-operative, and post-operative surgical treatment and care of the patient. Many known risk factors that contribute to SSIs include, but are not limited to age, nutritional status, co-morbidities, length of pre-operative stay, duration of operation, preoperative skin prep, and surgical techniques. In addition, there are certain surgical procedures in which the risks for developing SSI are greater than other surgical procedures. While there are various pre-operative and post-operative techniques or approaches to prevent these infections in patients undergoing surgeries, such as pre-operative skin care techniques, appropriate use of antibiotic prophylaxis, and the use of other post-operative anti-microbial methods, by immobilizing the patient's endogenous skin flora, an opportunity exists to reduce the rate of skin flora contamination which leads to wound contamination.

• Procedure: InteguSeal* skin sealant and standard surgical preparation
  Surgical skin preparation prior to incision using InteguSeal* skin sealant following standard surgical preparation with povidone iodine or 0.7% available iodine in isopropyl alcohol 74% w/w.
  Other Name: Kimberly Clark InteguSeal* Microbial Sealant
• Other: Standard preoperative skin preparation
  Surgical skin preparation prior to incision using standard surgical preparation with povidone iodine or 0.7% available iodine in isopropyl alcohol 74% w/w.

• Active Comparator: InteguSeal* and standard surgical preparation solutions
  InteguSeal* microbial skin sealant was applied to surgical sites prior to incision after standard surgical skin preparation in patients undergoing coronary artery bypass graft (CABG) surgery
  Intervention: Procedure: InteguSeal* skin sealant and standard surgical preparation
• Standard surgical skin preparation alone
  Prior to incision, standard surgical skin preparation in patients undergoing coronary artery bypass graft (CABG) surgery
  Intervention: Other: Standard preoperative skin preparation

• Dohmen PM. Influence of skin flora and preventive measures on surgical site infection during cardiac surgery. Surg Infect (Larchmt). 2006;7 Suppl 1:S13-7. Review.
• Malangoni MA, Cheadle WG, Dodson TF, Dohmen PM, Jones D, Katariya K, Kolvekar S, Urban JA. New opportunities for reducing risk of surgical site infection. Roundtable discussion. Surg Infect (Larchmt). 2006;7 Suppl 1:S23-39. No abstract available.
• Fernandez-Ayala M, Nan DN, Farinas-Alvarez C, Revuelta JM, Gonzalez-Macias J, Farinas MC. Surgical site infection during hospitalization and after discharge in patients who have undergone cardiac surgery. Infect Control Hosp Epidemiol. 2006 Jan;27(1):85-8. Epub 2006 Jan 6.
• Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132; quiz 133-4; discussion 96.
• Mertz PM, Davis SC, Cazzaniga AL, Drosou A, Eaglstein WH. Barrier and antibacterial properties of 2-octyl cyanoacrylate-derived wound treatment films. J Cutan Med Surg. 2003 Jan-Feb;7(1):1-6. Epub 2002 Oct 9.
• von Eckardstein AS, Lim CH, Dohmen PM, Pêgo-Fernandes PM, Cooper WA, Oslund SG, Kelley EL. A randomized trial of a skin sealant to reduce the risk of incision contamination in cardiac surgery. Ann Thorac Surg. 2011 Aug;92(2):632-7. Epub 2011 Jun 24.

Inclusion Criteria:

• Scheduled for an elective Coronary Artery Bypass Graft (CABG) surgical procedure with median sternotomy utilizing either the saphenous vein and/or radial artery as one of the graft sites within 28 days of the screening date, as documented by a Cardiothoracic Surgeon who is the Principal Investigator or sub-investigator. This includes subjects who are also receiving internal mammary artery grafts in addition to saphenous vein and/or radial artery grafts.
• The skin near or around the proposed incision sites should be intact.

Exclusion Criteria:

• Known sensitivity or allergy to cyanoacrylate, isopropyl alcohol, iodine or iodine-containing products or tape allergies.
• Female subjects that are nursing or actively lactating.
• Abnormal skin condition adjacent to or at the surgical incision sites.
• Hair removal at the surgical sites prior to entrance to the operating suite.
• Use of antimicrobial impregnated incise drapes (i.e. Ioban®).
• Hospital stay of >14 days immediately prior to scheduled CABG surgery.
• Use of chemotherapy agents, within 30 days prior to Visit 1 screening.
• Scheduled for additional chemotherapy for the duration of the study.
• Known positive Human Immunodeficiency Virus (HIV) with a CD4 count < 350 mm3. If HIV status is not known, the subject is not excluded.
• Currently taking antibiotics for an infection (within 30 days prior to Visit 1).
• Has had therapeutic radiation to the chest within 30 days of visit 1. This does not include subjects who receive chest xrays.
• Pre-operatively scheduled to have concomitant procedures with coronary artery bypass graft procedure.
• Scheduled to receive only one incision (a median sternotomy) without a planned saphenous vein graft and/or a radial artery graft donor site.
• Renal dialysis currently or within 30 days of visit 1.
• Morbid Obesity (Subjects with a Body Mass Index (BMI) > 37).
• Neutropenia (absolute neutrophil count <1000/mm3).
• Pre-operatively on an intra-aortic balloon pump or mechanical assist device.
• Has received an experimental drug or used an experimental medical device within 30 days prior to Visit 1.
• Employees of the investigator or study center with direct involvement in the proposed study or other studies under the direction of that investigator or study center.
• Any condition, which in the opinion of the investigator would exclude the subject from the study.
• Patients on steroid use for more than 1 week within 30 days of visit 1.
• Patients on immunosuppressive therapy within 30 days of visit 1.
• Depilatory creams with containing antibiotics.