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Chlorhexidine on SSI
Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty
Researchers from Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, USA have found that surgical site infections are the most commonly complication occur following elective knee arthroplasties as a result of colonization by the patient’s native skin flora.
A number of different strategies have been developed and reported for reducing the incidence of surgical site infections following knee arthroplasty. However, all of these strategies are limited to the area of the incision. While whole body bathing with antiseptic has been shown to reduce the bacterial load of the skin. However, this strategy presents challenges including: difficulties in achieving entire body coverage and in maintaining sufficiently high concentrations of solution on the skin following the wash for effective antisepsis.
Although the US Centres for Disease Control recommend that surgical patients be required to shower or bathe with an antiseptic agent the night before the operative day, there may be poor compliance when these efforts are patient-directed, and there are high costs if this is directed by the health care staff. Recently, a new no-rinse chlorhexidine-impregnated cloth has been developed which allows longer-term maintenance of an effective chlorhexidine concentration on the skin and also easy to use. Therefore, the purpose of this study was to evaluate the incidence of deep surgical site infections in knee arthroplasty patients who used an advance cutaneous disinfection protocol and who were compared to patients who had peri-operative preparation only. Records for all knee arthroplasties performed between January 2007 and December 2008 were reviewed to determine the incidence of deep incisional and periprosthetic surgical site infections.
This study was divided into 3 groups: patients who complete advance preparation protocols (hlorhexidine gluconate 2 % the evening before and morning of surgery), patients who underwent in-hospital preparation only and those who complied only partly with the advance protocol (either the morning of surgery or the evening before, but not both).
The result of the study was demonstrated that advance preoperative protocol was used in 136 of 912 total knee arthroplasties (15%). A lower incidence of surgical site infection was found in patients who used the advance cutaneous preparation protocol as compared to patients who used the in-hospital protocol alone (0/136 vs 21/711). These findings were maintained when patients were stratified by surgical infection risk category. Patient-directed skin disinfection using chlorhexidine gluconate-impregnated cloths the evening before, and the morning of, elective knee arthroplasty appeared to effectively reduce the incidence of surgical site infection when compared to patients who underwent in-hospital skin preparation only.
Ref: Zywiel MG, Daley JA, Delanois RE, Naziri Q, Johnson AJ, Mont MA. Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty. Int Orthop. 2011;35:1001-6.