Irrisept Solution for Instrumented Spine Surgery

NCT ID: NCT06439953

Last Updated: 2024-11-20

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

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-10-01

Study Completion Date

2026-09-30

Brief Summary

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Various spine surgeons perform wound irrigation using saline mixed with vancomycin, relying on mechanical debridement of non-viable tissue, physical disruption of biofilm, and bacteriostatic effect against gram positive flora. When used as a powder, topical application of vancomycin has demonstrated increased risk of symptomatic seroma formation, which is an adverse outcome that often requires bedside or intra-operative aspiration. Broad-spectrum antiseptic agents, such as Irrisept, offer bacteriocidal properties to eliminate hardware inoculation, thereby minimizing the risk of deep space infection, while obviating the risk of seroma development.

Detailed Description

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Spinal instrumentation remains the standard of care in the treatment of various traumatic, oncologic, and degenerative spinal pathologies, often requiring the implantation of hardware to stabilize the bony column. In the setting of an aging patient population and expanding indications for instrumentation in younger patients, the number of spinal operations performed has risen substantially within the past decade. Although these procedures have proven to enhance patient quality of life, spinal instrumentation is not without post-operative complication, most notable of which are surgical site infection, seroma formation, and wound breakdown. Such complications can result in notable negative sequelae. Recurrent seroma may compress underlying neurologic structures or increase pressure along the incision, thereby precipitating wound dehiscence and inoculation of the surgical site with pathogenic organisms. Deep space infections often result in prolonged hospitalization, long-term suppressive antibiotic therapy, hardware removal, and permanent disability, which increases cost burden at the patient and hospital level. As such, preventative strategies to reduce the rate of complications following spinal instrumentation remain paramount. Within recent years, attention has turned to various irrigation methods to terminally sterilize prosthetic devices and wound beds, thereby minimizing bacterial colonization and biofilm formation that would otherwise predispose infection.

Irrisept (Irrimax Corporation, Gainesville, Florida) is a solution comprised of 0.05% chlorhexidine gluconate in 99.95% sterile water administered through a proprietary, low-pressure lavage mechanism that has demonstrated efficacy as a bacteriocidal agent in orthopedic hip and knee arthroplasty procedures. Whereas other antiseptic irrigation solutions, such as vancomycin-saline lavage, are routinely used to prevent surgical site infection, relative inertness against gram negative organisms and potential predisposition toward seroma formation render them non-ideal for use in spine surgery. Despite the utility of dilute chlorhexidine gluconate as a prophylactic irrigant, there exist gaps in knowledge with regard to the efficacy of Irrisept to prevent post-operative complications following spinal instrumentation. The central hypothesis of this proposal is that prophylactic use of Irrisept irrigation will result in fewer surgical site infections, clinically significant seromas, and gram negative or atypical infections when compared to standard of care irrigation (vancomycin-saline solution with or without topical vancomycin powder).

Proposed is a prospective, randomized controlled trial comparing rates of post-operative complications following use of Irrisept irrigation alone versus vancomycin-saline lavage with or without topical vancomycin powder (standard of care) in patients aged 18 years or older who undergo posterior cervical, thoracic, lumbar, and/or sacral spinal instrumentation for various indications (deformity, malignancy, degenerative pathology, and trauma) at Rhode Island Hospital.

Conditions

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Post-Op Complication Spine Surgery Site Infection Surgical Site Infection Spinal Instrumentation Index Spinal Instrumentation Layer-by-Layer Closure Locoregional Flap-Based Closure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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Irrisept Irrigation

Patients scheduled to undergo spinal instrumentation will receive intra-operative Irrisept irrigation.

Group Type EXPERIMENTAL

Chlorhexidine gluconate solution

Intervention Type DEVICE

Evaluating the prophylactic use of Irrisept irrigation alone

Vancomycin-saline Irrigation

Patients scheduled to undergo spinal instrumentation will receive intra-operative irrigation using vancomycin-saline irrigation.

Group Type ACTIVE_COMPARATOR

Vancomycin

Intervention Type DRUG

Evaluating the use of versus vancomycin-saline irrigation with or without topical vancomycin

Interventions

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Chlorhexidine gluconate solution

Evaluating the prophylactic use of Irrisept irrigation alone

Intervention Type DEVICE

Vancomycin

Evaluating the use of versus vancomycin-saline irrigation with or without topical vancomycin

Intervention Type DRUG

Other Intervention Names

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Irrisept irrigation Vancomycin-saline

Eligibility Criteria

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Inclusion Criteria

* Age: 18+ years old
* Indications: deformity, oncologic, degenerative, trauma
* Standard layer-by-layer closure
* Locoregional flap-based closure

Exclusion Criteria

* Acute/chronic open wounds (spine or non-spine)
* On-going non-spinal infection within 30 days of index operation
* Concurrent antibiotic use (for spine or non-spine infections)
* History of prior spinal infection
* Allergy to vancomycin or chlorhexidine
* Suspicion for osteomyelitis
* Other surgery within 90 days post-operatively fromm index
* Concurrent enrollment in other trial
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rhode Island Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jared S. Fridley, MD

Role: PRINCIPAL_INVESTIGATOR

Rhode Island Hospital

Albert S. Woo, MD

Role: PRINCIPAL_INVESTIGATOR

Rhode Island Hospital

Locations

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Rhode Island Hospital

Providence, Rhode Island, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Alexander Chernysh

Role: CONTACT

401-444-9868

Owen Leary

Role: CONTACT

401-6068388

Facility Contacts

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Alexander Chernysh

Role: primary

401-444-9868

Jared S. Fridley, MD

Role: backup

Albert S. Woo, MD

Role: backup

References

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Other Identifiers

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2095643

Identifier Type: -

Identifier Source: org_study_id

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