title: Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty.
abstract: Surgical site infections following elective knee arthroplasties occur most commonly as a result of colonisation by the patient's native skin flora. The purpose of this study was to evaluate the incidence of deep surgical site infections in knee arthroplasty patients who used an advance cutaneous disinfection protocol and who were compared to patients who had peri-operative preparation only. All adult reconstruction surgeons at a single institution were approached to voluntarily provide patients with chlorhexidine gluconate-impregnated cloths and a printed sheet instructing their use the night before and morning of surgery. Records for all knee arthroplasties performed between January 2007 and December 2008 were reviewed to determine the incidence of deep incisional and periprosthetic surgical site infections. Overall, the advance pre-operative protocol was used in 136 of 912 total knee arthroplasties (15%). A lower incidence of surgical site infection was found in patients who used the advance cutaneous preparation protocol as compared to patients who used the in-hospital protocol alone. These findings were maintained when patients were stratified by surgical infection risk category. No surgical site infections occurred in the 136 patients who completed the protocol as compared to 21 infections in 711 procedures (3.0%) performed in patients who did not. Patient-directed skin disinfection using chlorhexidine gluconate-impregnated cloths the evening before, and the morning of, elective knee arthroplasty appeared to effectively reduce the incidence of surgical site infection when compared to patients who underwent in-hospital skin preparation only.
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Zywiel
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Daley
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Delanois
authors.forename: Qais
authors.initials: Q
authors.lastname: Naziri
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Johnson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002710:Chlorhexidine / Q000627:therapeutic use*; D005260:Female; D006622:Hip Prosthesis / Q000382:microbiology; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D057234:Preoperative Period; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine