At Issue Chlorhexidine gluconate bathing

摘要

Surgical?site?infection?is?a?devastating?complication?after?orthopedic?surgery.?There?has?been?much?debate?regardingthe?efficacy?of?chlorhexidine?gluconate?for?presurgical?bathing?to?reduce?surgical?site?infection?risk.?A?presurgicalshower?with?2%?or?4%?aqueous?chlorhexidine?gluconate,?or?CHG,?was?designated?as?“strongly?recommended”?in?the1999?CDC?Guideline?for?the?Prevention?of?[surgical?site?infection]?SSI?based?on?the?ability?of?CHG?to?reduce?theskin’s?microbial?colony?counts?without?definitive?evidence?of?reducing?SSI.?A?number?of?studies?have?beenpublished?in?the?orthopedic?literature?since?that?time?with?contradictory?findings?regarding?infection?reduction.?Arandomized?controlled?trial?that?Bhaveen?H.?Kapadia,?MD,?and?colleagues?conducted?in?patients?undergoingarthroplasty?demonstrated?a?lower?rate?of?SSI?with?preoperative?use?of?CHG?over?soap?and?water,?while?a?systematicreview?by?Joan?Webster,?RN,?RM,?BA,?and?colleagues?in?the?Cochrane?database?of?10,157?patients?showed?no?clearbenefit?of?CHG?over?other?wash?products.?A?recent?international?consensus?paper?by?Gerald?J.?Atkins,?PhD,?andcolleagues?on?orthopedic?infections?expressed?a?moderate?evidence?recommendation?of?CHG?for?presurgical?bathingbased?on?a?potential?upside?with?limited?downside.?However,?the?paper?concluded?the?current?literature?could?notaffirm?emphatically?that?skin?cleansing?at?home?has?a?role?in?the?reduction?of?SSI.