A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery

Abstract

Objectives:Chlorhexidine is seen as the golden standard of disinfectants. It is widely used to clean surgical sites; however, many studies indicate resistance of pathogens to chlorhexidine. One study indicated that pathogenic microorganisms were isolated from the soft palate cleft region in 57% of patients with facial clefts. The objectives of our study were to determine (1) if chlorhexidine application is effective in removing pathogens from the surgical site in these patients, and (2) if any pathogens are isolated, determine if they are resistant to other antimicrobials. Design:A descriptive observational study. Settings:A private practice that specializes in facial cleft surgery, with a country-wide patient base. All procedures were executed by one oral and maxillofacial surgeon.Participants: All patients (N=50) who presented for primary repair of the soft palate cleft were included in the study. Inclusion criteria: written consent from parent(s), and patient cleared as systemically healthy by a pediatric physician. Exclusion criteria: patient(s) with systemic infections (eg, flu) and/or any local infections (eg, tonsillitis). There were 25 males and 25 females with an average age of 7 months and 16 days included in the study.Methods: Swabs were taken from the surgical site of all 50 patients with cleft soft palate and were sent for culture, identification and antimicrobial sensitivity. The swabs were taken before disinfecting the site as well as after 2 minutes of disinfecting the surgical site with chlorhexidine. Results were compared against each other.Results: Positive cultures with 28 different pathogenic microorganisms that were identified in 47 patients before cleaning the surgical site with the chlorhexidine. The most dominant pathogens were K. pneumonia (n=22), H. influenza (n=18) and S. aureus (n=10). Of the pathogens found, 13 (46%) were still present on the swabs taken after disinfecting with chlorhexidine. K. pneumonia (n= 13), H. influenza (n=11) and S. aureus (n=9) were still the most prevalent pathogens. Conclusions:This study demonstrated that 61 of the total of 113 pathogens isolated (54%), survived after 2 minutes of disinfecting the surgical and surrounding area with chlorhexidine, thus intensifying the chances of post-operative infection.

Oral Flora and Perioperative Antimicrobial Interventions in Cleft Palate Surgery: A Review of the Literature

“…Nonetheless, only chlorhexidine, to our knowledge, has been tested in the cleft population. One study found a reduction in intraoral flora by approximately 50% following surgical site preparation of the palate with chlorhexidine (Roode and Butow, 2018). In this study, S aureus growth persisted in approximately 90% of cases.…”

“…This is supported by studies suggesting that there are anatomical site-specific colonization rates in cleft patients (Cocco et al, 2010), that closure of the cleft reduces oral pathogen burden (Arief et al, 2005;Cocco et al, 2010), and that the size of fistulae directly correlates with pathogen transmission (Tuna et al, 2008). Furthermore, the rate of antibiotic resistance among commonly encountered oral bacteria in cleft patients appears high (Myburgh and Butow, 2009;Roode et al, 2017;Roode and Butow, 2018).…”

Dental plaque control strategies for the elderly population: A scoping review

“…55 As an anti-plaque agent, CHX is considered the gold standard by some authors. 55,56 Despite the benefits described above, prolonged use of CHX may cause several adverse effects such as: extrinsic staining of teeth, restorations, prostheses or tongue, 57 as well as taste alterations, reversible angioedema or swelling of the parotid glands, and desquamation of the oral mucosa. 58 There is evidence that the 0.2% CHX mouthwash provides a significantly greater reduction of plaque than 0.12% and 0.06% concentrations.…”

Microbial contamination profile change over a 4‐year period in nonoperated cleft soft palate

“…Different studies have examined the micro‐flora in facial clefts in infants and toddlers with seven of these identifying micro‐organisms preoperatively (Arief et al, 2005; Bokhout et al, 1996; Chuo & Timmons, 2005; Cocco et al, 2010; Myburgh & Bütow, 2009; Roode & Bütow, 2018; Roode et al, 2016). A study that aimed to identify possible pathogenic organisms associated with postoperative wound complications cultured 15 different pathogenic organisms preoperatively from 100 babies (Myburgh & Bütow, 2009).…”

“…All these are pathogens that can contribute to postoperative infections. Another study on the resistance of pathogens against chlorhexidine in patients with preoperative cleft soft palate isolated 28 different pathogenic micro‐organisms from 50 patients (Roode & Bütow, 2018).…”