Study: Home Use of Chlorhexidine Not Helpful

Preoperatively reducing bacterial count sounds smart, right? Well, it isn’t supported by the latest research.

A team from New York, including K. Daniel Riew, M.D., director of Cervical Spine Surgery at the Spine Hospital at New York-Presbyterian in Manhattan, has found that using chlorhexidine gluconate wipes at home before surgery wasn’t particularly beneficial. Their work, “No Clear Benefit of Chlorhexidine Use at Home Before Surgical Preparation,” appears in January 15, 2018 edition of The Journal of the American Academy of Orthopaedics Surgeons.

Dr. Riew told OTW, “When I got to Columbia, the department protocol was to use chlorhexidine (CHG) wipes to cleanse the surgical site the night before surgery. My personal protocol, which I have used since 2005, involves the following surgical prep: we square off the operative field with plastic drapes, do a pre-prep with alcohol foam and then do a standard CHG prep. It’s simple and doesn’t rely on the patient doing anything.”

“In over 2,000 posterior cervical spine cases since 2005, I have had zero infections. So I didn’t want to mess with my protocol. But I also wanted to be a team player and thought that the best way to determine if the at-home CHG made any difference was to do a study.”

“We reviewed the literature and found problems with most of the studies in the literature. These included the fact that the CHG manufacturer sponsored one of the studies and most of them just looked at bacterial counts on the day of surgery and before the surgical prep.”

“That made little sense to me.”

“If you do the CHG wipe the night before surgery and then sleep in a non-sterile bed, how is that going to help prevent infections? A good surgical prep will kill all bacteria, no matter how high the bacterial count and the pre-hospital diminution by some factor is not likely to be relevant, once you do a surgical prep. To use an analogy, if you are going to use an atom bomb, using some rubber bullets the night before to get rid of a few enemies seems like a waste of time, effort and rubber bullets to me.”

“We found that all 17 participants had no bacterial growth from their skin swab, following a standard surgical prep. Most importantly, there was no difference between using and not using CHG wipes the night before surgery. It appears that using CHG wipes the night before surgery has no benefits in decreasing bacterial counts, once a standard surgical prep is performed.”

“Our study suggests that if you do a standard surgical prep in the operating room, that prep will kill all skin organisms.”

“So decreasing the bacterial count before coming into the hospital may sound appealing, but it has little scientific merit when it comes to posterior cervical spine wounds. One could certainly argue that CHG wipes are not expensive and pose little risk. But one could make the same argument to advise patients to shower before coming in to the hospital. Neither is likely to affect skin bacterial counts after a standard surgical prep. But if it makes the surgeon and/or patient feel better, I don’t object. But don’t do it based on scientific evidence, because the evidence is flawed.”

“Finally, the reader should bear in mind that our findings may not be generalizable to other parts of the body that might have a higher bacterial count to begin with, such as the foot.”