Newer infection prevention techniques , such as preoperative antiseptic scrubbing , are affected and may help reduce the infection rate , while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate
Despite advances in our underst and ing of surgical site infections following total joint arthroplasty , this serious surgical complication continues to represent a substantial economic burden for the patient , the treating institution and the healthcare system .
After increasing for the past decade , infection rates have stabilized at 1.6 % ; however , the total cost is projected to increase with the total number of revision procedures performed .
Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission?
BACKGROUND Skin asepsis is a sentinel strategy for reducing risk of  surgical site infections .  In this study , chlorhexidine gluconate ( CHG ) skin concentrations were determined after preoperative showering/skin cleansing using 4 % CHG soap or 2 % CHG-impregnated polyester cloth . STUDY DESIGN Subjects were r and omized to one of three shower ( 4 % soap)/skin cleansing ( 2 % cloth ) groups ( n = 20 per group ) : ( group 1 A/B ) evening , ( group 2 A/B ) morning , or ( group 3 A/B ) evening and morning . After showering or skin cleansing , volunteers returned to the investigator 's laboratory where  CHG skin surface concentrations were determined at five separate skin sites . CHG concentrations were compared with CHG minimal inhibitory concentration that inhibits 90 % ( MIC(90 ) ) of staphylococcal skin isolates . RESULTS CHG MIC(90 ) for 61 skin isolates was 4.8 parts per million ( ppm ) . In group 1A , 4 % CHG skin concentrations ranged from 17.2 to 31.6 ppm , and CHG concentrations were 361.5 to 589.5 ppm ( p < 0.0001 ) in group 1B ( 2 % ) . In group 2A ( 4 % ) , CHG levels ranged from 51.6 to 119.6 ppm and 848.1 to 1,049.6 ppm in group 2B ( 2 % ) , respectively ( p < 0.0001 ) . CHG levels ranged from 101.4 to 149.4 ppm in the 4 % CHG group ( group 3A ) compared with 1,484.6 to 2,031.3 ppm in 2 % CHG cloth ( group 3B ) group ( p < 0.0001 ) . Effective CHG levels were not detected in the 4 % CHG group in selected sites in seven ( 35 % ) subjects in group 1A , three ( 15 % ) in group 2A , and five ( 25 % ) in group 3A . CONCLUSIONS Effective CHG levels were achieved on most skin sites after using 4 % CHG ; gaps in antiseptic coverage were noted at selective sites even after repeated application . Use of the 2 % CHG polyester cloth result ed in considerably higher skin concentrations with no gaps in antiseptic coverage . Effective decolonization of the skin before hospital admission can play an important role in reducing risk of surgical site infections
Newer infection prevention techniques , such as preoperative antiseptic scrubbing , are affected and may help reduce the infection rate , while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate
Despite advances in our underst and ing of surgical site infections following total joint arthroplasty , this serious surgical complication continues to represent a substantial economic burden for the patient , the treating institution and the healthcare system .
After increasing for the past decade , infection rates have stabilized at 1.6 % ; however , the total cost is projected to increase with the total number of revision procedures performed .