J Knee Surg 2013; 26(03): 213-218
DOI: 10.1055/s-0032-1329232
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Chlorhexidine Reduces Infections in Knee Arthroplasty

Aaron J. Johnson
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
Bhaveen H. Kapadia
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
Jacqueline A. Daley
2   Infection Prevention and Control, Sinai Hospital of Baltimore, Baltimore, Maryland
Christine B. Molina
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
Michael A. Mont
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

23 February 2012

23 August 2012

Publication Date:
12 November 2012 (online)


The purpose of this study was to evaluate the incidence of surgical site infections in total knee arthroplasty patients using a preadmission cutaneous skin preparation protocol compared with a cohort of patients undergoing standard in-hospital perioperative preparation only. Records between 2007 and 2010 were reviewed to identify deep incisional and periprosthetic infections among patients using the chlorhexidine protocol (478 patients) and patients who did not use the protocol (1,735 patients). Patients using the chlorhexidine cloths were given two packets of six chlorhexidine gluconate–impregnated cloths, with instructions for use, the evening before and morning of surgery. A statistically lower incidence of surgical site infection was found in patients using the chlorhexidine cloths (0.6%) compared with patients undergoing in-hospital perioperative skin preparation only (2.2%). On the basis of the results of this study, a preadmission chlorhexidine protocol seems to be an effective method to prevent surgical site infections in total knee arthroplasty procedures.

  • References

  • 1 Buechel Sr FF, Buechel Jr FF, Pappas MJ, Dalessio J. Twenty-year evaluation of the New Jersey LCS Rotating Platform Knee Replacement. J Knee Surg 2002; 15 (2) 84-89
  • 2 Ritter MA, Berend ME, Meding JB, Keating EM, Faris PM, Crites BM. Long-term follow up of anatomic graduated components posterior cruciate-retaining total knee replacement. Clin Orthop Relat Res 2001; (388) 51-57
  • 3 Jakobsson J, Perlkvist A, Wann-Hansson C. Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: a systematic review. Worldviews Evid Based Nurs 2011; 8 (3) 143-152
  • 4 Parvizi J, Pawasarat IM, Azzam KA, Joshi A, Hansen EN, Bozic KJ. Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty 2010; 25 (6) (Suppl): 103-107
  • 5 Eiselt D. Presurgical skin preparation with a novel 2% chlorhexidine gluconate cloth reduces rates of surgical site infection in orthopaedic surgical patients. Orthop Nurs 2009; 28 (3) 141-145
  • 6 Edmiston Jr CE, Okoli O, Graham MB, Sinski S, Seabrook GR. Evidence for using chlorhexidine gluconate preoperative cleansing to reduce the risk of surgical site infection. AORN J 2010; 92 (5) 509-518
  • 7 National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32 (8) 470-485
  • 8 Gillespie WJ. Prevention and management of infection after total joint replacement. Clin Infect Dis 1997; 25 (6) 1310-1317
  • 9 Darouiche RO, Wall Jr MJ, Itani KM , et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010; 362 (1) 18-26
  • 10 Borst M, Collier C, Miller D. Operating room surveillance: a new approach in reducing hip and knee prosthetic wound infections. Am J Infect Control 1986; 14 (4) 161-166
  • 11 Evans RP. Current concepts for clean air and total joint arthroplasty: laminar airflow and ultraviolet radiation: a systematic review. Clin Orthop Relat Res 2011; 469 (4) 945-953
  • 12 Ritter MA, Olberding EM, Malinzak RA. Ultraviolet lighting during orthopaedic surgery and the rate of infection. J Bone Joint Surg Am 2007; 89 (9) 1935-1940
  • 13 Lipke VL, Hyott AS. Reducing surgical site infections by bundling multiple risk reduction strategies and active surveillance. AORN J 2010; 92 (3) 288-296
  • 14 Zywiel MG, Daley JA, Delanois RE, Naziri Q, Johnson AJ, Mont MA. Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty. Int Orthop 2011; 35 (7) 1001-1006
  • 15 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999; 20 (4) 250-278
  • 16 Parvizi J, Zmistowski B, Berbari EF , et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
  • 17 Culver DH, Horan TC, Gaynes RP , et al; National Nosocomial Infections Surveillance System. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991; 91 (3B) 152S-157S
  • 18 Swenson BR, Hedrick TL, Metzger R, Bonatti H, Pruett TL, Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infect Control Hosp Epidemiol 2009; 30 (10) 964-971
  • 19 Edmiston Jr CE, Krepel CJ, Seabrook GR, Lewis BD, Brown KR, Towne JB. Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission?. J Am Coll Surg 2008; 207 (2) 233-239
  • 20 Stinner DJ, Krueger CA, Masini BD, Wenke JC. Time-dependent effect of chlorhexidine surgical prep. J Hosp Infect 2011; 79 (4) 313-316