Pre-Admission Chlorhexidine Gluconate Reduces Surgical Site Infections vs. Peri-Operative Skin Preparation

SAN DIEGO, CA—For total knee arthroplasty, a pre-admission protocol using cutaneous chlorhexidine gluconate cloths significantly reduced the incidence of surgical site infections as opposed to receiving in-hospital peri-operative skin preparation only, according to a study presented IDWeek 2012 by Bhaveen H. Kapadia, MD, from the Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore in Baltimore, MD.

Most surgical infections transpire as a product of colonization of patients' native flora. The treatment of periprosthetic infections often necessitates numerous surgeries, imposing a considerable burden on patients, surgeons, and hospitals.

In the study, patients who were scheduled to undergo total knee arthroplasty were given six 2% chlorhexidine gluconate-saturated cloths, with written directives for their utilization, for application the evening before and morning of surgery. Cloths were applied to the neck/chest/abdomen, arms, each leg, back, and surgical site. Compliance was confirmed at hospital admission and noted in the institution's infection control database.

Records from total knee arthroplasties performed in 2,293 patients from 2007–2010 were examined to determine the incidence of deep incisional and periprosthetic infections. Patients were monitored for 1 year from the operative date. Definitions used for diagnosis were from the Centers for Disease Control and Prevention and the Musculoskeletal Infection Society.

A statistically significant lower incidence of surgical site infections was seen in patients who utilized the chlorhexidine gluconate cloths. Three surgical site infections occurred among 478 patients (0.6%) who used the chlorhexidine cloths vs. 38 surgical site infections that occurred among 1,735 patients (2.2%) who underwent in-hospital peri-operative preparation only (P=0.02).

For the protocol used in the study, Dr. Kapadia noted that further investigation is necessary to build on and assess tactics for maximizing surgeon and patient compliance. He stated, in regard to the suggested effectiveness of the prophylactic method used for infection in total knee arthroplasty patients, “This study confirms prior, underpowered preliminary studies”.