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Neurosurgery. 2018 Dec 22. doi: 10.1093/neuros/nyy568. [Epub ahead of print]

Chlorhexidine Showers are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries.

Author information

1
Department of Neurosurgery, University of California, San Francisco, San Francisco, California.
2
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
Department of Hospital Epidemiology and Infection Control, University of California, San Francisco, San Francisco, California.
4
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Institute and Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington.

Abstract

BACKGROUND:

Surgical site infection (SSI) is a common complication following spinal surgery. Prevention is critical to maintaining safe patient care and reducing additional costs associated with treatment.

OBJECTIVE:

To determine the efficacy of preoperative chlorhexidine (CHG) showers on SSI rates following fusion and nonfusion spine surgery.

METHODS:

A mandatory preoperative CHG shower protocol was implemented at our institution in November 2013. A cohort comparison of 4266 consecutive patients assessed differences in SSI rates for the pre- and postimplementation periods. Subgroup analysis was performed on the type of spinal surgery (eg, fusion vs nonfusion). Data represent all spine surgeries performed between April 2012 and April 2016.

RESULTS:

The overall mean SSI rate was 0.4%. There was no significant difference between the pre- (0.7%) and postimplementation periods (0.2%; P = .08). Subgroup analysis stratified by procedure type showed that the SSI rate for the nonfusion patients was significantly lower in the post- (0.1%) than the preimplementation group (0.7%; P = .02). There was no significant difference between SSI rates for the pre- (0.8%) and postimplementation groups (0.3%) for the fusion cohort (P = .21). In multivariate analysis, the implementation of preoperative CHG showers were associated with significantly decreased odds of SSI (odds ratio = 0.15, 95% confidence interval [0.03-0.55], P < .01).

CONCLUSION:

This is the largest study investigating the efficacy of preoperative CHG showers on SSI following spinal surgery. In adjusted multivariate analysis, CHG showering was associated with a significant decrease in SSI following spinal surgery.

PMID:
30590721
DOI:
10.1093/neuros/nyy568

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