title: Preoperative skin disinfection methodologies for reducing prosthetic joint infections.
abstract: Surgical site infections following lower extremity total joint arthroplasty procedures remain a substantial economic burden to the patient, the treating institution, and the health care system. The complexity of these surgical procedures creates the potential for various patient- or surgery-related risk factors for infection. Although there is much literature regarding the use of many preventative methods, a consensus regarding the true efficacy and application of such practices is generally not available. In this review, we reviewed the preoperative skin disinfection methodologies that have been used for reducing periprosthetic infections following lower extremity total joint arthroplasty. Currently, cumulative evidence suggests that preoperative chlorhexidine baths or chlorhexidine-impregnated wipes may reduce the colonization of pathogenic organisms on the skin. In addition, multiple showers or topical applications of chlorhexidine may lead to more substantial reduction in colony counts. Advanced preoperative whole-body cleaning with chlorhexidine-containing cloths rather than site-specific application may confer additional advantages. Further randomized controlled trials with carefully planned protocols and endpoints are needed to determine if this conclusively leads to reduction in the rate of surgical site infections.
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Samik
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001494:Baths; D002710:Chlorhexidine / Q000008:administration & dosage*; D004203:Disinfection; D006801:Humans; D017613:Iodine Compounds / Q000008:administration & dosage; D011300:Preoperative Care; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D012915:Soaps / Q000008:administration & dosage
chemical_list: D000891:Anti-Infective Agents, Local; D017613:Iodine Compounds; D012915:Soaps; D002710:Chlorhexidine