Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit?

Edmiston, Charles E.; Bruden, Benjamin; Rucinski, Maria C.; Henen, Cindy R.; Graham, Mary Beth; Lewis, Brian

doi:10.1016/j.ajic.2012.10.030

Cited by 130 publications

(110 citation statements)

References 60 publications

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“…38 However, little is known about the effect this substance has on the early adhesive interaction of oral streptococci bacteria with surfaces. To evaluate the effect of CHX on the adhesion of S. sanguinis to Ti surfaces, the initial buffer was replaced by a solution of 2 mg/mL CHX in TRIS.…”

Section: Poisson Analysis Of Unbinding Events For Force Decouplingmentioning

confidence: 99%

“…First, CHX is a positively charged molecule with the ability to bind to substrates and negatively charged bacterial surfaces, 6 and therefore its presence may increase the binding affinity between the probe and Ti surface. Second, CHX exposure has been shown to alter the mechanical properties of the bacterial cell and cause membrane damage, 38,39 which could also lead to increased adhesion due to increased compliance of the bacterium against the surface during probing. A similar increase in adhesion force and work was observed for S. aureus bacterial probes when probed against smooth Ti surfaces in the presence of CHX, however, we found this effect to be more pronounced in the case of S. sanguinis.…”

Section: Poisson Analysis Of Unbinding Events For Force Decouplingmentioning

confidence: 99%

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Probing the nanoadhesion of Streptococcus sanguinis to titanium implant surfaces by atomic force microscopy

Aguayo¹,

Donos²,

Spratt³

et al. 2016

IJN

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As titanium (Ti) continues to be utilized in great extent for the fabrication of artificial implants, it is important to understand the crucial bacterium–Ti interaction occurring during the initial phases of biofilm formation. By employing a single-cell force spectroscopy technique, the nanoadhesive interactions between the early-colonizing Streptococcus sanguinis and a clinically analogous smooth Ti substrate were explored. Mean adhesion forces between S. sanguinis and Ti were found to be 0.32±0.00, 1.07±0.06, and 4.85±0.56 nN for 0, 1, and 60 seconds contact times, respectively; while adhesion work values were reported at 19.28±2.38, 104.60±7.02, and 1,317.26±197.69 aJ for 0, 1, and 60 seconds, respectively. At 60 seconds surface delays, minor-rupture events were modeled with the worm-like chain model yielding an average contour length of 668±12 nm. The mean force for S. sanguinis minor-detachment events was 1.84±0.64 nN, and Poisson analysis decoupled this value into a short-range force component of −1.60±0.34 nN and a long-range force component of −0.55±0.47 nN. Furthermore, a solution of 2 mg/mL chlorhexidine was found to increase adhesion between the bacterial probe and substrate. Overall, single-cell force spectroscopy of living S. sanguinis cells proved to be a reliable way to characterize early-bacterial adhesion onto machined Ti implant surfaces at the nanoscale.

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Section: Poisson Analysis Of Unbinding Events For Force Decouplingmentioning

confidence: 99%

Section: Poisson Analysis Of Unbinding Events For Force Decouplingmentioning

confidence: 99%

Probing the nanoadhesion of Streptococcus sanguinis to titanium implant surfaces by atomic force microscopy

Aguayo¹,

Donos²,

Spratt³

et al. 2016

IJN

View full text Add to dashboard Cite

show abstract

“…[13][14][15] There have been varying reports in the literature regarding the effectiveness of preoperative CHG use in reducing infection amongst the TJA population. [16][17][18] A study by Leaper et al supported that the use of 2% CHG as a preoperative deterrence of SSIs.…”

Section: Discussionmentioning

confidence: 99%

Does a one hour educational class improve compliance of chlorhexidine gluconate baths prior to operation?

Levieddin

Chen

Kim

et al. 2017

CSS

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Background: Surgical site infections (SSIs) continue to be a major contributor to morbidity and mortality post-operatively. One of the treatments used to prevent such infections is chlorhexidine gluconate (CHG) baths prior to surgery. An obstacle to using CHG as a pre-operative preventative measure to infection has been the low patient compliance rates. Our study aimed to analyze whether an educational class explaining the proper usage of CHG prior to the surgery date will improve patient compliance. Methods: We evaluated two different groups. One group consisted of patients who were scheduled for total joint arthroplasty (TJA) and attended an educational class in addition to receiving the standard preoperative protocol explaining the proper application of CHG. A second group consisted of subjects undergoing any other type of surgery but was not offered the additional educational class. Results: Subjects undergoing TJA had a higher compliance rate than all other surgeries (95.8% and 77.8% respectively; p < .001). Interestingly, throughout time, the effectiveness of the educational class to improve compliance also improved (from 90.9% in the first month to 100% in the final month; p < .001). Discussion: The addition of an educational class to the standard preoperative educational protocol significantly improved patient compliance to the preoperative application of CHG in TJA Patients, and increasingly so overtime. This suggests the importance of proper patient education in the prevention of costly comorbidities such as infection. Conclusions: The use of instructional classes may be useful for improving compliance to patient protocols prior to undergoing surgery. Further research is needed to fully assess the benefits of educational classes and their correlation to patient compliance.

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“…It also has a beneficial effect on the prevention of SSI and should replace the inappropriate use of antiseptics or antibiotics. 16 The CHG has a joint beneficial effect on the prevention of SSI with hand washing, skin preparation and sterile dressings covering the surgical wound. 15,16 Besides, several studies suggested that the use of CHG for surgical wound irrigation was associated with improved patient recovery as well as reduced costs in health management.…”

Section: 3mentioning

confidence: 99%

“…16 The CHG has a joint beneficial effect on the prevention of SSI with hand washing, skin preparation and sterile dressings covering the surgical wound. 15,16 Besides, several studies suggested that the use of CHG for surgical wound irrigation was associated with improved patient recovery as well as reduced costs in health management. [17][18][19] Currently, CHG 0.05% has been used in some hospital operating rooms in México.…”

mentioning

confidence: 99%

Surgical Wound Irrigation: Strategy for Prevention of Surgical Site Infection

Zamudio¹

2017

NCOAJ

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A recent prevalence study found that surgical site infections (SSI) were the most common healthcare-associated infection (HAI), accounting for 31% of all HAIs among hospitalized patients. 1 The World Health Organization (WHO) report on the global burden of endemic HAI-SSI incidence was 11.8 per 100 surgical patients undergoing surgical procedures (95% CI:8.6-16.0) and 5.6 per 100 surgical procedures (95% CI:2.9-10.5).2 SSI extends the postoperative hospitalization by an average of 9.7 days and increased health care and costs of US $ 20,842. 3 In Mexico; in the years 2014 and 2015, the Department of Epidemiology of Health reported that there were 15 incidents of surgical site infection in 100 entries, the mortality was 25.5%, the additional hospital stay ranged from 7 to 20.7 days, and the unit costs per episode was more than USD 6,005 per episode. 3,4 Several prevention strategies and policies regarding the SSI prevention have been established, including preoperative bathing, surgical site preparation, antimicrobial skin, surgical hand preparation, antimicrobial prophylaxis 5 and the most recent and updated one is the global guidelines for the prevention of surgical infection initiated by the WHO. While several evidence-based recommendations were established previously for the preoperative, trans-operative and postoperative prevention of surgical site infection, the WHO guideline is the first to recommend surgical wound irrigation as an important strategy. 2,3Specifications solutions, pressure, containers and axillary substancesIn México, orthopedic surgeons made a consensus in 2013 which recognized the theoretical basis of irrigation to reduce wound infection but without establishing specifications in methods and irrigation solution to be used. 6 Saline irrigation reduces infection when compared with the non-irrigated cases. 7,8 Irrigation pressure below 15 pounds per square inch (psi) and above 35 psi was regarded as low and high pressure respectively while the use of low pressure is recommended, as the use of high pressure causes damage to the adjacent tissue and the process of healing. 9 Regarding the containers for the irrigation solution at the procedure field, one study showed that in 13 of 21 irrigating solutions in containers were contaminated at the end of the surgical procedures. [10][11][12] Our experience recommends the use of sterile devices and adapters to avoid contamination of the solution and hence reduce SSI incidence.The Food and Drugs Administration (FDA) has warned the inappropriate use of antibiotics in surgical wound irrigation as it increases antimicrobial resistance and reduces the effectiveness of established antibiotic treatments and increased health costs and mortality. 13,14 The antiseptics are also commonly used (the most common one is the iodopovidone) in the surgical wound irrigation to exert a bactericidal effect, but it also lacks FDA's authorization. Evidence found it associated with cellular toxicity and delayed the healing process. Particularly, similar findings were obser...

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Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit?

Cited by 130 publications

References 60 publications

Probing the nanoadhesion of Streptococcus sanguinis to titanium implant surfaces by atomic force microscopy

Probing the nanoadhesion of Streptococcus sanguinis to titanium implant surfaces by atomic force microscopy

Does a one hour educational class improve compliance of chlorhexidine gluconate baths prior to operation?

Surgical Wound Irrigation: Strategy for Prevention of Surgical Site Infection

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