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Randomized Controlled Trial
. 2025 Jun 18;107(Suppl 1):36-42.
doi: 10.2106/JBJS.24.01224.

Chlorhexidine Gluconate Bathing Has Limited Ability to Prevent Surgical Site Infection Following Operative Fixation of Extremity and Pelvic Fractures

Michael C Willey  1 , Joan N Hebden  2 , Loreen A Herwaldt  3   4 , Greg E Gaski  5 , Sara Kheiri  6 , Lyndsay M O'Hara  2 , Nathan N O'Hara  6 , Sheila Sprague  7   8 , Sofia Bzovsky  7 , Mark J Gage  9 , Gerard P Slobogean  6 ; the PREP-IT Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Chlorhexidine Gluconate Bathing Has Limited Ability to Prevent Surgical Site Infection Following Operative Fixation of Extremity and Pelvic Fractures

Michael C Willey et al. J Bone Joint Surg Am. .

Abstract

Background: A preoperative chlorhexidine gluconate (CHG) bath is used to reduce the risk of surgical site infection (SSI) in elective surgery, but its efficacy in the trauma setting is unknown. We compared the incidence of SSI between patients who did versus did not receive a CHG bath before operative fixation of extremity and/or pelvic fractures.

Methods: We conducted a secondary analysis of the PREP-IT cluster-randomized crossover trials that enrolled patients undergoing operative treatment for open or closed extremity or pelvic fractures. Preoperative CHG bathing (yes or no) was recorded for each patient per study protocol. The association between CHG bathing and SSI within 90 days after definitive fracture surgery was assessed. We performed multivariable regression to adjust for prognostic variables. We also conducted a separate instrumental variable analysis to compare SSI rates between study sites that used CHG bathing for >90% of participants and those that used CHG bathing for <1% of participants.

Results: Of the 10,103 participants (mean age, 51 ± 20 years; 47% female; 77% White; 17% Black; 4% Asian; 7% Hispanic) included in the analysis, 2,674 (26%) had a documented preoperative CHG bath and 7,429 (74%) did not. CHG bathing was not associated with a significant reduction in the odds of 90-day SSI in the multivariable (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.86 to 1.32; p = 0.56) or instrumental variable (OR, 0.88; 95% CI, 0.62 to 1.25; p = 0.48) analyses.

Conclusions: Among adult patients who underwent extremity or pelvic fracture surgery, preoperative CHG bathing was not associated with a significant reduction in SSI.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: The Aqueous-PREP trial was funded by the U.S. Department of Defense (W81XWH-17-1-070), a Canadian Institutes of Health Research Foundation Grant, McMaster University Surgical Associates, and the PSI (Physicians’ Services Incorporated) Foundation. The PREPARE trial was funded by the Patient-Centered Outcomes Research Institute (PCS-1609-36512) and a Canadian Institutes of Health Research Foundation Grant. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I585).

References

    1. Morris BJ, Unger RZ, Archer KR, Mathis SL, Perdue AM, Obremskey WT. Risk factors of infection after ORIF of bicondylar tibial plateau fractures. J Orthop Trauma. 2013 Sep;27(9):e196-200.
    1. Ruffolo MR, Gettys FK, Montijo HE, Seymour RB, Karunakar MA. Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions. J Orthop Trauma. 2015 Feb;29(2):85-90.
    1. Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma. 2004 Nov-Dec;18(10):649-57.
    1. Foster AL, Warren J, Vallmuur K, Jaiprakash A, Crawford R, Tetsworth K, Schuetz MA. A population-based epidemiological and health economic analysis of fracture-related infection. Bone Joint J. 2024 Jan 1;106-B(1):77-85.
    1. Iliaens J, Onsea J, Hoekstra H, Nijs S, Peetermans WE, Metsemakers WJ. Fracture-related infection in long bone fractures: A comprehensive analysis of the economic impact and influence on quality of life. Injury. 2021 Nov;52(11):3344-9.

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