Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?

Abstract

Background Periprosthetic hip infections are among the most catastrophic complications after total hip arthroplasty (THA). We had previously proven that the use of chlorhexidine cloths before surgery may help decrease these infections; hence, we increased the size of the previously reported cohort. Questions/purposes (1) Does a preadmission chlorhexidine cloth skin preparation protocol decrease the risk of surgical site infection in patients undergoing THA? (2) When stratified using the National Healthcare Safety Network (NHSN) risk categories, which categories are associated with risk reduction from the preadmission chlorhexidine preparation protocol? Methods Between 2007 and 2013, a group of 998 patients used chlorhexidine cloths before surgery, whereas a group of 2846 patients did not use them and underwent standard perioperative disinfection only. Patient records were reviewed to determine the development of periprosthetic infection in both groups of patients. Results Patients without the preoperative chlorhexidine gluconate disinfection protocol had a higher risk of infections (infections with protocol: six of 995 [0.6%]; infections in control: 46 of 2846 [1.62%]; relative risk: 2.68 [95% confidence interval {CI}, 1.15-0.26]; p = 0.0226). When stratified based on risk category, no differences were detected; preadmission chlorhexidine preparation was not associated with reduced infection risk for low, medium, and high NHSN risk categories (p = 0.386, 0.153, and 0.196, respectively). Conclusions The results of our study suggest that this cloth application appears to reduce the risk of infection in patients undergoing THA. When stratified by risk categories, we found no difference in the infection rate, but these findings were underpowered. Although future multicenter randomized trials will need to confirm these preliminary findings, the intervention is inexpensive and is unlikely to be risky and so might be considered on the basis of this retrospective, comparative study. Level of Evidence Level III, therapeutic study.

Prospective Randomized Trial Comparing the Efficacy of Surgical Preparation Solutions in Hand Surgery

“…2,4,11,16 It also accrues significant health care cost with revision surgeries and postoperative infection control. 16,[13][14][15]17 The ideal skin preparation solution would eliminate all bacteria from the skin prior to incision, have effects that last the duration of the surgical procedure, and have a low risk of complications and side effects.…”

Irrigation and Debridement for Periprosthetic Hip Infection: Does Timing Play a Role?

“…Although our study presents a unique perspective on the management of periprosthetic hip infections, innovative measures have been aimed at reducing the rate of PJIs. These promising preventative measures include: cutaneous chlorhexidine preparations, 22 identification and medical optimization of modifiable risk factors, 23 and the implementation of integrated care pathways (ICPs) for all surgical candidates, particularly high-risk patients. 24 As these measures are utilized, it is critical that orthopaedic surgeons continue to assess available treatment modalities with the goal of matching patients to the most effective therapies.…”

Prévention de l'infection en salle d'opération excluant l'antibiothérapie

“…Elle est inférieure à 1 % pour une chirurgie propre chez des patients à faible risque, cas habituel de la chirurgie prothétique programmée, mais peut aller jusqu'à 15 % pour une chirurgie contaminée chez des patients à risque, situation que l'on rencontre surtout en chirurgie traumatique d'urgence [1][2][3].…”