Postoperative Wound Infections in Vascular Surgery: Effect of Preoperative Whole Body Disinfection by Shower-bath with Chlorhexidine Soap

Abstract

Bacterial flora on the patient's own skin is an important source of postopera-tive wound infections.l.2 Washing with chlorhexidine solution reduces the skin flora. Data on this reduction by preoperative hand washing are published by Lowbury and Lilly4 and by Smylie et a1. 6 ; reduction of anaerobic and aerobic skin flora after local disinfection of different skin areas, by Nielsen et al.;5 and reduction of S. aureus, by Lindberg. 3 This investigation studies the effect of preoperative total body disinfection by means of a shower-bath with chlorhexidine soap on the frequency of post-operative infections in vascular surgery. Material and Methods The study was prospective but not randomized. At Sahlgrens Hospital, Gote-borg, Sweden, 341 patients from the vascular surgical units operated on with groin incision were studied. Data on sex, age, and number of patients with severe complications are in Table 13.1. All acute operations were omitted. Two groups were studied: 171 patients were preoperatively prepared in the established standard routine at the clinic. This included shaving and preoperative local washing of the operation site with chlorhexidine soap (Hibiscrub), followed by local disinfection with chlorhexidine 0.5% in 70% alcohol. The other group, 170 patients, were preoperatively prepared by means of a shower-bath with chlorhexidine soap repeated 3-8 times prior to going through the same routine as the control group. Except for the method with preoperative total body disinfection it was possible to keep most of the routines constant: the indications for operation were the same, as were the operating technique, equipment, and theater. The surgeons and the major part ofthe nursing staff were the same, pre-and postoperative care were performed in the same ward, antibiotic policy remained unchanged, and the same surgeon classified all infections. All H. I. Maibach et al. (eds.), Skin Microbiology