No infection reduction using chlorhexidine wipes in total joint arthroplasty

Background: Surgical site infection (SSI) after total joint arthroplasty (TJA) is a rare but devastating complication. Various skin antiseptic applications are used preoperatively to prevent SSI. Recent literature suggests 2% chlorhexidine gluconate (CHG) wipes reduce microbial content at surgical sites, but it is unclear whether they reduce rates of SSI. Questions/purposes: We compared the SSI rates between TJAs with and without CHG wipe use (1) with all TJAs in one group and (2) stratified by surgical subgroup (THA, TKA). Methods: We retrospectively reviewed all 3715 patients who underwent primary TJA from 2007 to 2009. CHG wipes were introduced at our facility on April 21, 2008. We compared SSI of patients before (n = 1824) and after (n = 1891) the introduction of CHG wipes. The wipes were applied 1 hour before surgery. There were 1660 patients with THA (845 CHG, 815 no CHG) and 2055 patients with TKA (1046 CHG, 1009 no CHG). Infections were diagnosed based on the Musculoskeletal Infection Society Guidelines for periprosthetic joint infection. All patients were tracked for 1 year. Results: SSI incidences were similar in patients receiving (1.0%, 18 of 1891) and not receiving (1.3%, 24 of 1824) CHG wipes. In patients with THA, there was no difference in SSI between those receiving (1.2%, 10 of 845) and not receiving (1.5%, 12 of 815) CHG wipes. In patients with TKA, there also was no difference in SSI between those receiving (0.8%, eight of 1046) and not receiving (1.2%, 12 of 1009) CHG wipes. Conclusions: Introduction of CHG-impregnated wipes in the presurgical setting was not associated with a reduced SSI incidence. Our analysis suggests CHG wipes in TJA are unnecessary as an adjunct skin antiseptic, as suggested in previous smaller studies. Level of Evidence: Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.