Chlorhexidine Provides Superior Skin Decontamination in Foot and Ankle Surgery

Abstract

Therapeutic study, Level I-1a (significant difference). See the Guidelines for Authors for a complete description of levels of evidence.

What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

“…Other comorbidities associated with increased risk of postoperative infection include obesity, malnutrition, tobacco use, and immunosuppressive medication [11,21,43,45]. Another potential cause for greater concern for surgical site infections after foot and ankle surgery is the persistent colonization of the forefoot despite preoperative preparation [7,12,30,47,48,63,65]. Ostrander et al [47] reported positive cultures after application of surgical preparation solution in 125 patients, ranging from 23% to 98% from the hallux nailfold and second and third web spaces, compared with 10% to 35% from the anterior tibia control.…”

“…Ostrander et al [47] reported positive cultures after application of surgical preparation solution in 125 patients, ranging from 23% to 98% from the hallux nailfold and second and third web spaces, compared with 10% to 35% from the anterior tibia control. Multiple studies have reported postpreparation forefoot cultures ranging from 0% to 84%, most reporting greater than 50% [7,12,28,30,48,63,65]. Studies also have shown intraoperative forefoot recolonization [12,63,65].…”

“…Investigation to decrease infectious risk in foot and ankle surgery has been largely preoperative, including preoperative risk stratification [17,21,59,64] and evaluation of antiseptic skin preparations [7,12,30,47,48]. An additional measure taken by some foot and ankle surgeons is planned use of a brief course of prophylactic postoperative oral antibiotics after elective outpatient procedures.…”

A Comparitive Study of Chlorhexidine Alcohol versus PovidoneIodine for Pre-operative Skin Preparation

“…[2] The superior clinical efficacy of chlorhexidine-alcohol in our study correlates well with previous microbiologic studies showing that chlorhexidine-based antiseptic preparations are more effective than iodine-containing solutions in reducing the bacterial concentration in the operative field for vaginal hysterectomy [3] and foot-and-ankle surgery. [4,5] Although the use of flammable alcohol-based products in the operating room poses the risk, though small, of fire or chemical skin burn, no such adverse events occurred in this study or the other studies. [3,5] Chlorhexidine is a cationic biguanide that binds to the negatively charged surface of bacterial cell wall leading to alteration in permeability, which leads to leakage of cytoplasmic contents and finally cell death.…”

“…[4,5] Although the use of flammable alcohol-based products in the operating room poses the risk, though small, of fire or chemical skin burn, no such adverse events occurred in this study or the other studies. [3,5] Chlorhexidine is a cationic biguanide that binds to the negatively charged surface of bacterial cell wall leading to alteration in permeability, which leads to leakage of cytoplasmic contents and finally cell death. [6] The residual effect; defined as the long-term antimicrobial suppressive activity; of chlorhexidine gluconate, is prolonged (at least 6 h) while that of povidone-iodine is minimal.…”