Abstract
Introduction
Periprosthetic infection following lower extremity total joint arthroplasty often requires multiple surgical procedures and imposes a marked economic burden on the patient and hospital. The purpose of this study was to evaluate the incidence of surgical site infections in total joint arthroplasty patients who used an advance at-home pre-admission cutaneous preparation protocol and to compare these results to a cohort of patients who underwent standard in-hospital peri-operative preparation only.
Methods
Patients scheduled for surgery were given two packets of 2% chlorhexidine gluconate-impregnated cloths, with instructions for use the evening before and morning of surgery. Records between 2007 and 2010 were reviewed to identify deep incisional and periprosthetic infections. The Centers for Disease Control and Prevention and the Musculoskeletal Infection Society definitions were used for diagnosis.
Results
A significantly lower incidence of surgical site infections was found in the chlorhexidine preparation group. For total hip arthroplasty, three surgical site infections occurred in 557 patients (0.5%) of the chlorhexidine group compared to 32 of 1,901 patients (1.7%) in the control group. For total knee arthroplasty, three surgical site infections occurred in 478 patients (0.6%) who used the chlorhexidine cloths, compared to 38 surgical site infections in 1,735 patients (2.2%) in the control group.
Discussion
The use of an advance pre-admission chlorhexidine protocol significantly reduced the incidence of surgical site infections in total joint arthroplasty when compared to patients who did not use this protocol. This study validates prior studies in orthopaedics suggesting this as an effective method to prevent periprosthetic infections.
