Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery

Murray, Michael; Saltzman, Matthew D.; Gryzlo, Stephen M.; Terry, Michael A.; Woodward, Chase C.; Nuber, Gordon W.

doi:10.1016/j.jse.2011.02.018

Cited by 85 publications

(51 citation statements)

References 20 publications

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“…The chlorhexidine protocol required one application the evening before and another one the morning of surgery, similar to that of patients in this study. No patients in either the control or experimental group developed infections (zero of 50 for both groups); however, cultures revealed that there was a threefold decrease in the colony count for patients who received chlorhexidine, which has been demonstrated in additional studies [2,19,28]. Although the results of our study are supportive of the use of chlorhexidine cloths for preoperative sterilization, other studies have reported findings in opposition to ours.…”

Section: Discussionsupporting

confidence: 46%

“…In a randomized, prospective study done by Murray et al, 100 patients were evaluated for the effectiveness of chlorhexidine cloths compared with that of a shower with soap and water the morning of surgery [19]. The chlorhexidine protocol required one application the evening before and another one the morning of surgery, similar to that of patients in this study.…”

Section: Discussionmentioning

confidence: 91%

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

Kapadia

Zhou

Jauregui

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Many preventive methodologies seek to reduce the risk of surgical site infections after total knee arthroplasty (TKA), including the use of preoperative chlorhexidine baths and cloths. Although we have demonstrated in previous studies that this may be an efficacious method for infection prevention, our study was underpowered and we therefore set out to evaluate this with a larger sample size. Questions/purposes (1) Does a preadmission chlorhexidine cloth skin preparation protocol decrease the risk of surgical site infection in patients undergoing TKA? (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 In our study, all patients (3717 total) who had undergone primary or revision TKA at a single institution between January 1, 2007, and December 31, 2013, were identified, of whom 991 patients used the chlorhexidine cloths before surgery and 2726 patients did not. All patients were provided cloths with instructions before surgery; however, as a result of a lack of compliance, we were able to substratify patients into treatment and control cohorts. Additionally, we substratified patients by NHSN risk category to determine differences in infection between the two cohorts (cloth versus no cloth). Patient medical records and an infection-tracking database were reviewed to determine the development of periprosthetic infection (patients who had superficial infections were excluded from our study) in both groups after 1 year surveillance. We then calculated relative risk reductions with use of chlorhexidine gluconate and stratified results based on NHSN risk category. RR, 8.3 [CI,; p = 0.038), but no significant difference was detected in the low-and medium-risk groups (RR, 2.1 [CI, 0.5-9.6; p = 0.33] and RR, 11.3 [CI,; p = 0.09]).

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 91%

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

Kapadia

Zhou

Jauregui

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…It is commonly assumed that the patient's epidermal skin surface is the source of the Propionibacterium grown on culture of specimens from infected orthopaedic implant sites. Unfortunately, presurgical skin surface preparations do not completely eliminate Propionibacterium [39][40][41][42] , perhaps because the organism is sheltered in dermal sebaceous glands, each of which may harbor as many as 10 5 Propionibacterium organisms per follicle 43 . Surgical incisions transect the sebaceous glands, after which these organisms may Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work.…”

Section: Discussionmentioning

confidence: 99%

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

Matsen

Butler-Wu

Carofino³

et al. 2013

The Journal of Bone & Joint Surgery

147

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“…Previous literature has underlined the important role of chlorhexidine or alcoholic iodinated polyvidone in the prevention of these infections. 20,21 Slow intravenous administration of antibioprophylaxis with cefazolin 2 g, as recommended by the French Society of Anesthesia and Reanimation, has a low success rate for controlling P. acnes. 22 Despite standard skin preparation and prophylactic antibiotics, the rate of deep tissue inoculation with P. acnes in shoulder arthroscopy is much higher than the rate of infection reported in the literature.…”

Section: Preventionmentioning

confidence: 99%

Propionibacterium acnes as a cause of shoulder osteoarthritis after three shoulder arthroscopies: a case report and review of preventive action

et al. 2017

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We report a case of postoperative osteoarthritis infection caused by P. acnes after shoulder arthroscopy, and review possible preventive action. A right-handed 24-year-old man presented an anterior instability of the left shoulder. The patient underwent an anterior stabilization by the latarjet procedure. Stabilization failed, requiring a second and third surgery. The patient returned 10 months later for suspected septic arthritis of his left shoulder. An arthroscopy lavage with bacteriological and anatomo-pathological sampling was carried out. The bacteriological results revealed a positive P. acnes culture. The patient was treated using antibiotherapy for 12 weeks with a combination of clindamicin and moxifloxacin. C-reactive protein (CRP) was negative two months after the onset of antibiotherapy. P. acnes is a anaerobic, non-sporulated, gram-positive bacillus. This commensal germ is part of the normal cutaneous flora and causes acne, but has also been recognized as a causative pathogen in osteoarticular infections since the 1990s, as described by Coden. Treatment is achieved via surgical debridement and intravenous antibiotics. We insist on preventive action in the form of a preoperative patient preparation protocol. Previous literature has underlined the important role of chlorhexidine or alcoholic iodinated polyvidone in the prevention of these infections. As P. acnes is a commensal germ of the patient's skin, prophylaxis should be reinforced by the thorough preparation of the surgery and surgical site. Clindamycin antibioprophylaxy specific to this germ should be administered for this surgery. To my knowledge, there is no specific antibioprophylaxy for shoulder surgery to date.

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Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery

Cited by 85 publications

References 20 publications

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

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

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

Propionibacterium acnes as a cause of shoulder osteoarthritis after three shoulder arthroscopies: a case report and review of preventive action

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