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

Michael C. Willey; Joan N. Hebden; Loreen A. Herwaldt; Greg E. Gaski; Sara Kheiri; Lyndsay M. O'Hara; Nathan N. O'Hara; Sheila Sprague; Sofia Bzovsky; Mark J. Gage; Gerard P. Slobogean; PREP-IT Investigators

doi:10.2106/JBJS.24.01224

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

Journal article

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

Michael C. Willey, Joan N. Hebden, Loreen A. Herwaldt, Greg E. Gaski, Sara Kheiri, Lyndsay M. O'Hara, Nathan N. O'Hara, Sheila Sprague, Sofia Bzovsky, Mark J. Gage, …

Journal of bone and joint surgery. American volume, Vol.107(Suppl 1), pp.36-42

06/18/2025

DOI: 10.2106/JBJS.24.01224

PMID: 40531185

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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.

Details

Title: Subtitle: Chlorhexidine Gluconate Bathing Has Limited Ability to Prevent Surgical Site Infection Following Operative Fixation of Extremity and Pelvic Fractures
Creators: Michael C. Willey - University of Iowa Hospitals and Clinics
Joan N. Hebden - University of Maryland, Baltimore
Loreen A. Herwaldt - University of Iowa
Greg E. Gaski - Inova Fairfax Hospital
Sara Kheiri - University of Maryland, Baltimore
Lyndsay M. O'Hara - Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Nathan N. O'Hara - Center for Orthopaedics
Sheila Sprague - McMaster University
Sofia Bzovsky - McMaster University
Mark J. Gage - University of Maryland, Baltimore
Gerard P. Slobogean - University of Maryland, Baltimore
PREP-IT Investigators
Resource Type: Journal article
Publication Details: Journal of bone and joint surgery. American volume, Vol.107(Suppl 1), pp.36-42
DOI: 10.2106/JBJS.24.01224
PMID: 40531185
NLM abbreviation: J Bone Joint Surg Am
ISSN: 0021-9355
eISSN: 1535-1386
Publisher: Journal of Bone and Joint Surgery, Inc
Number of pages: 7
Grant note: U.S. Department of Defense: W81XWH-17-1-070 Canadian Institutes of Health Research Foundation GrantMcMaster University Surgical AssociatesPSI (Physicians' Services Incorporated) FoundationPatient-Centered Outcomes Research Institute: PCS-1609-36512
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.
Language: English
Date published: 06/18/2025
Academic Unit: Infectious Diseases; Epidemiology; Orthopedics and Rehabilitation; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984832191502771

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