A Randomized Controlled Trial of 2% Chlorhexidine Gluconate Skin Preparation Cloths for the Prevention of Surgical Site Infections in Adults Undergoing Spine Surgeries: Residual Reduction in Skin Bacterial Load for 4 Days

Authors

Elizabeth Card, Vanderbilt University Medical CenterFollow
Yaping Shi, Vanderbilt University Medical CenterFollow
Wuraola Adesinasi, Vanderbilt University Medical CenterFollow
Matt Shotwell, Vanderbilt University Medical CenterFollow
Nancy Wells, Vanderbilt University Medical CenterFollow
Elizabeth Hall, Belmont UniversityFollow
Joseph Cheng, University of CincinnatiFollow
Edward Sherwood, Vanderbilt University Medical CenterFollow

Keywords

chlorhexidine gluconate (CHG); neuro-spine surgery; skin bacterial load; surgical site infections (SSI)

Disciplines

Nursing

Abstract

Background

Surgical site infections (SSI) result in increased morbidity and mortality, prolonged recovery, longer hospital length of stay for medication or possible additional surgeries, and escalated health care costs. The purpose of this randomized controlled trial was to compare SSI rates and overall skin flora burden between those using chlorhexidine (CHG) cloths versus soap and water preoperatively in the adult spine surgery population.

Methods

Subjects were randomized preoperatively to use 2% CHG cloths versus soap and water the night before and morning of surgery prior to the operation. A skin culture was obtained at enrollment prior to any cleansing, again at post-operation day 4 or hospital discharge (whichever came first), and finally at the surgeons’ postoperative visits. A blinded advanced practice nurse served as the assessor for SSI.

Results

Those enrolled in the research arm had more growth on their screening skin culture than the control arm (P = .02). While there was no difference in rates of SSI between groups, the CHG group had lower skin flora burden at hospital discharge (P = .004), indicating residual protection.

Conclusion

Surgical incisions are most vulnerable to bacterial entry prior to 72 hours post-operation before completion of epithelialization, which establishes a barrier from microbes. The use of CHG, which has a residual impact for up to 4 days, could offer additional risk reduction for SSI development.

Recommended Citation

Card, Elizabeth; Shi, Yaping; Adesinasi, Wuraola; Shotwell, Matt; Wells, Nancy; Hall, Elizabeth; Cheng, Joseph; and Sherwood, Edward (2024) "A Randomized Controlled Trial of 2% Chlorhexidine Gluconate Skin Preparation Cloths for the Prevention of Surgical Site Infections in Adults Undergoing Spine Surgeries: Residual Reduction in Skin Bacterial Load for 4 Days," HCA Healthcare Journal of Medicine: Vol. 5: Iss. 5, Article 9.
DOI: 10.36518/2689-0216.1997
Available at: https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol5/iss5/9