title: Use of chlorhexidine-impregnated patch at pin site to reduce local morbidity: the ChIPPS Pilot Trial.
abstract: Pin tract infection is one of the most common complications associated with the use of external fixation. While some studies have identified the potential benefit of chlorhexidine gluconate-impregnated polyurethane dressings to reduce the incidence of catheter-related bloodstream infections, we are unaware of any published studies that evaluate the effectiveness of similar technologies in reducing the risk for external-fixation-related pin tract infections. Therefore, the purpose of this study was to evaluate the effectiveness of chlorhexidine gluconate-impregnated polyurethane dressing in reducing percutaneous-device-related skin colonisation and local infections. In this initial retrospective cohort, data were abstracted for two groups of consecutive patients undergoing surgery involving external fixation at an interdisciplinary foot and ankle surgical unit. All patients received surgical treatment of their foot/ankle pathology along with application of a hybrid external fixator. Twenty patients (45% male, age 54.5 +/- 3.69 years) received chlorhexidine gluconate-impregnated polyurethane dressing and twenty (55% male, age 55.8 +/- 3.22 years) received standard pin care. There was a significantly higher rate of pin tract infection in patients who received standard pin care compared with those who received chlorhexidine gluconate-impregnated polyurethane dressings (25% versus 0%, P = 0.047). There was no significant difference in any of the descriptive study characteristics (age, gender, diabetes and presence of neuropathy). The results of this initial study suggest that chlorhexidine gluconate-impregnated polyurethane dressing may be effective to reduce the incidence of pin tract infections and help decrease morbidity associated with external fixation.
authors.affiliation: Scholl's Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine, Chicago, IL 60064, USA.
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Wu
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Crews
authors.forename: Charles
authors.initials: C
authors.lastname: Zelen
authors.forename: James S
authors.initials: JS
authors.lastname: Wrobel
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000494:pharmacology; D001424:Bacterial Infections / Q000517:prevention & control; D001458:Bandages / Q000592:standards; D002179:Candidiasis, Cutaneous / Q000517:prevention & control; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D016267:External Fixators / Q000009:adverse effects* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011140:Polyurethanes; D011182:Postoperative Care / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D017592:Skin Care / Q000295:instrumentation / Q000379:methods; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D011140:Polyurethanes; C010882:chlorhexidine gluconate; D002710:Chlorhexidine