367. Pre-operative CHG Without Nasal Decolonization to Reduce Orthopedic SSI
Session: Poster Abstract Session: HAI: Surgical Site Infections
Thursday, October 8, 2015
Room: Poster Hall
  • CHGhipkneerevision_IDweek2015poster_FINAL.pdf (664.1 kB)
  • Background: Pre-operative screening for Staphylococcus aureus colonization with subsequent decolonization is a recommended optional strategy to reduce surgical site infections (SSI), but is logistically challenging.  We elected to implement pre-operative skin decolonization alone for all patients, using chlorhexidine gluconate (CHG) cloths, prior to elective hip and knee replacement surgeries (HPRO and KPRO, respectively).

    Methods: At our 2-hospital, 1100-bed community-based academic health care system, approximately 850 HPRO and 1600 KPRO are performed annually.  Most patients undergoing HPRO or KPRO attended a “joint class” prior to surgery, at which they were given CHG cloths (Sage, Inc.) and instructions, starting in May 2013.  Materials were mailed to patients unable to attend class.  Patients were instructed to use 1 cloth around the surgical site the night before, and the 2ndcloth the morning of surgery.  Staff documented whether the cloths were used when the patient arrived for surgery.  We conducted SSI surveillance using NHSN definitions, and calculated SSI rates and standardized infection ratios (SIRs). 

    Results: During the baseline period (Jan 2012 - April 2013), the HPRO SSI rate was 0.9/100 surgeries, and the KPRO SSI rate was 0.5/100.  After implementation of the CHG cloths (May 2013 - May 2015), the HPRO SSI rate declined to 0.7/100 (rate ratio, 0.8, 95% CI 0.3-1.8) and the KPRO SSI rate declined to 0.3/100 (rate ratio, 0.7, 95% CI 0.4-1.3).  The HPRO SIR decreased from 0.81 (95% CI 0.4-1.5) to 0.68 (95% CI 0.4-1.1), while the KPRO SIR decreased from 0.54 (95% CI 0.26-0.99) to 0.39 (95% CI 0.21-0.68).  Of those who did develop SSI, only 50% of KPRO and 33% of HPRO patients had documented use of the CHG cloths.  The proportion of cultures that grew S. aureus declined from 68% (n=17) to 53% (n=9) for HPRO, and from 50% (n=12) to 36% (n=5) for KPRO.

    Conclusion: In a setting with low baseline KPRO and HPRO SSI rates, the addition of preoperative bathing with CHG cloths demonstrated a trend toward total as well as S. aureus SSI reduction, even without concurrent nasal decolonization.  The majority of patients who developed SSI did not use the CHG cloths.  Larger studies are needed to determine whether this strategy is effective in other settings where pre-operative S. aureus screening and nasal decolonization are not feasible.

    Marci Drees, MD, MS1, Carol Briody, MT (ASCP), CIC2, Cynthia Noble, MSN, RN-BC2, Theresa Foraker, MSN, RN ONC2 and Brian Galinat, MD, MBA2, (1)Christiana Care Health System, Newark, DE, (2)Christiana Care Health System, Wilmington, DE


    M. Drees, None

    C. Briody, None

    C. Noble, None

    T. Foraker, None

    B. Galinat, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.