FALCON Trial Testing Measures to Reduce Surgical Site Infection

NCT ID: NCT03700749

Last Updated: 2019-09-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

5480 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-11-29

Study Completion Date

2021-07-31

Brief Summary

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FALCON is a Pragmatic multi-centre trial testing measures to reduce superficial or deep skin infection following abdominal surgery in low and middle income countries. The trial will recruit patients undergoing abdominal surgery. Recruited participants will be randomly assigned to four arms to receive different combinations of skin preparation and sutures for would closure:

A. In this arm surgeon will use 2% alcoholic chlorhexidine for skin cleansing and non-coated suture for wound closure; B. In this arm surgeon will use 2% alcoholic chlorhexidine for skin cleansing and triclosan coated suture for wound closure; C. In this arm surgeon will use for operation 10% aqueous povidone-iodine for skin cleansing and non-coated suture for wound closure; D. In this arm surgeon will use 10% aqueous povidone-iodine for skin cleansing and triclosan-coated suture.

Detailed Description

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FALCON is a pragmatic, blinded (patient and outcome assessor), 2x2 factorial, stratified, multi-centre randomised controlled trial, with an internal pilot, to evaluate measures to reduce Surgical Site Infection (SSI) rates in patients undergoing surgery with an abdominal incision.

Surgical site infection (SSI) represents a major burden for patients, doctors, and health systems across all settings. SSI is the commonest postoperative complication worldwide and the commonest healthcare-associated infection in low and middle income countries (LMICs). SSIs cause pain, discomfort, disability, and increase the time taken to return to work (3). SSIs increase healthcare costs in all health settings. Whilst there is no direct data on the costs of SSI in LMICs, within the UK National Health Service, SSIs cost approximately £3500 per patient and £700 million per year in total. The impact of increased healthcare costs on patients, communities, and providers can be major in LMICs where personal income is low and patients may be required to pay for their own treatment. SSI has also been associated with one-third of postoperative deaths and accounts for 8% of all deaths caused by a hospital acquired infection.

Strata in FALCON trial are defined according to the anticipated category of wound contamination: (1) clean-contaminated and (2) contaminated/dirty. Eligible patients will be randomised at the level of the individual in a 1:1:1:1 ratio between:

A. 2% alcoholic chlorhexidine and non-coated suture B. 2% alcoholic chlorhexidine and triclosan-coated suture C. 10% aqueous povidone-iodine and non-coated suture D. 10% aqueous povidone-iodine and triclosan-coated suture.

Participant will be recruited from hospitals in Low and Middle Income Countries (LMICs). Participants who is undergoing abdominal surgery with an anticipated clean-contaminated, contaminated or dirty surgical wound will be selected to enter the trial.

The 6 month internal pilot will assess the feasibility of recruitment, compliance with treatment allocation and patient retention and follow-up rates. The main RCT will recruit 5480 participants.

Conditions

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Abdominal Surgery Surgical Site Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

FALCON 2x2 factorial trial with strata: (1) clean-contaminated and (2) contaminated/dirty. Eligible patients will be randomised at the level of the individual in a 1:1:1:1 ratio between:

A. 2% alcoholic chlorhexidine and non-coated suture B. 2% alcoholic chlorhexidine and triclosan-coated suture C. 10% aqueous povidone-iodine and non-coated suture D. 10% aqueous povidone-iodine and triclosan-coated suture
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Patients and outcome assessors will be blinded. The operating surgeon will not perform outcome assessment.

Study Groups

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2%chlorhexidine + non-coated suture

2%alcoholic chlorhexidine + non-coated suture. Intervention: skin preparation with 2%alcoholic chlorhexidine in combination with non-coated suture for abdominal fascial closure.

Group Type ACTIVE_COMPARATOR

2% chlorhexidine + non-coated suture

Intervention Type DRUG

Interventions:

2% alcoholic chlorhexidine non-coated suture

2%chlorhexidine + coated suture

2%alcoholic chlorhexidine + triclosan-coated suture. Intervention: skin preparation with 2%alcoholic chlorhexidine in combination with triclosan-coated suture for abdominal fascia closure.

Group Type ACTIVE_COMPARATOR

2% chlorhexidine + coated suture

Intervention Type DRUG

Interventions:

2% alcoholic chlorhexidine triclosan coated suture

10% povidone-iodine + non-coated suture

10% povidone-iodine and non-coated suture. Intervention: skin preparation with 10% povidone-iodine in combination with non-coated suture for abdominal fascial closure.

Group Type ACTIVE_COMPARATOR

10%povidone-iodine + non-coated suture

Intervention Type DRUG

Interventions:

10% povidone-iodine non-coated suture non-coated suture

10%povidone-iodine + coated suture

10%povidone-iodine/triclosan-coated suture. Intervention: skin preparation with 10% povidone-iodine in combination with triclosan-coated suture for abdominal fascial closure.

Group Type ACTIVE_COMPARATOR

10%povidone-iodine + coated suture

Intervention Type DRUG

Interventions:

10% povidone-iodine triclosan coated suture

Interventions

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2% chlorhexidine + non-coated suture

Interventions:

2% alcoholic chlorhexidine non-coated suture

Intervention Type DRUG

2% chlorhexidine + coated suture

Interventions:

2% alcoholic chlorhexidine triclosan coated suture

Intervention Type DRUG

10%povidone-iodine + non-coated suture

Interventions:

10% povidone-iodine non-coated suture non-coated suture

Intervention Type DRUG

10%povidone-iodine + coated suture

Interventions:

10% povidone-iodine triclosan coated suture

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients with at least one abdominal incision that is ≥5cm (open or laparoscopic extraction site), with an anticipated clean-contaminated, contaminated or dirty surgical wound.
* Patients undergoing emergency (surgery on an unplanned admission) or elective (surgery on a planned admission) operations.
* Any operative indication, including trauma surgery.
* Patient able and willing to provide written informed consent (signature or a fingerprint).
* Paediatric and adult patients. This criteria is made country-specific. Each country decides the lower age limit for the trial. This is dependent on country-specific regulatory approvals. Age eligibility will vary by country.

Exclusion Criteria

* Patients with a documented or suspected allergy to iodine, shellfish, or chlorhexidine skin preparation solution.
* Patient unable to complete post-operative follow-up (i.e. will not be contactable after discharge).
Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Lagos State University

OTHER

Sponsor Role collaborator

Universidad Francisco Marroquín

OTHER

Sponsor Role collaborator

Kigali University Teaching Hospital

OTHER

Sponsor Role collaborator

Christian Medical College and Hospital, Ludhiana, India

OTHER

Sponsor Role collaborator

University of Edinburgh

OTHER

Sponsor Role collaborator

University of the Philippines

OTHER

Sponsor Role collaborator

King Edward Medical University

OTHER

Sponsor Role collaborator

University of Witwatersrand, South Africa

OTHER

Sponsor Role collaborator

Universidad Peruana Cayetano Heredia

OTHER

Sponsor Role collaborator

Centre National Hospitalier Universitaire

UNKNOWN

Sponsor Role collaborator

Ndola Teaching Hospital

UNKNOWN

Sponsor Role collaborator

Hospital Espanol de Veracruz

UNKNOWN

Sponsor Role collaborator

Ministry of Health, Ghana

OTHER_GOV

Sponsor Role collaborator

University of Birmingham

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dion Morton

Role: PRINCIPAL_INVESTIGATOR

University of Birmingham

Locations

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Lagos University Teaching Hospital

Lagos, , Nigeria

Site Status RECRUITING

Countries

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Nigeria

Central Contacts

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Tina Griffin, BMedSc

Role: CONTACT

0121 414 4762

Rachel Lillywhite, BA

Role: CONTACT

0121 414 4762

References

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NIHR Global Health Research Unit on Global Surgery. Mechanisms and causes of death after abdominal surgery in low-income and middle-income countries: a secondary analysis of the FALCON trial. Lancet Glob Health. 2024 Nov;12(11):e1807-e1815. doi: 10.1016/S2214-109X(24)00318-8. Epub 2024 Sep 5.

Reference Type DERIVED
PMID: 39245053 (View on PubMed)

NIHR Global Health Research Unit on Global Surgery. Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries. Br J Surg. 2024 Jan 31;111(2):znad446. doi: 10.1093/bjs/znad446.

Reference Type DERIVED
PMID: 38747515 (View on PubMed)

Monahan M, Glasbey J, Roberts TE, Jowett S, Pinkney T, Bhangu A, Morton DG, de la Medina AR, Ghosh D, Ademuyiwa AO, Ntirenganya F, Tabiri S; NIHR Global Research Health Unit on Global Surgery. The costs of surgical site infection after abdominal surgery in middle-income countries: Key resource use In Wound Infection (KIWI) study. J Hosp Infect. 2023 Jun;136:38-44. doi: 10.1016/j.jhin.2023.03.023. Epub 2023 Apr 21.

Reference Type DERIVED
PMID: 37086854 (View on PubMed)

NIHR Global Research Health Unit on Global Surgery. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet. 2022 Nov 19;400(10365):1767-1776. doi: 10.1016/S0140-6736(22)01884-0. Epub 2022 Oct 31.

Reference Type DERIVED
PMID: 36328045 (View on PubMed)

NIHR Global Research Health Unit on Global Surgery. Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial. Lancet. 2021 Nov 6;398(10312):1687-1699. doi: 10.1016/S0140-6736(21)01548-8. Epub 2021 Oct 25.

Reference Type DERIVED
PMID: 34710362 (View on PubMed)

Other Identifiers

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RG_17-126

Identifier Type: -

Identifier Source: org_study_id

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