Authors' objectives: Background: Clean surgery is elective surgery, that does not enter the alimentary, respiratory or urinary tracts and without inflammation, infection or cellulitis in, or close to the operative field. Surgical site infection (SSI) following clean surgery occurs in from 1-3% after major joint implant surgery up to 10 - 38%, after, e.g., vascular and scrotal surgery respectively. Between 50 and 95 % of SSIs occur after discharge from the hospital. Serious SSI, usually implant infection, is a devastating complication with significant morbidity and mortality. Risk reducing strategies target environmental as well as patient related factors. Chlorhexidine gluconate (CHX) has a broad-spectrum activity and is known to reduce the risk for colonization of micro-organisms as well as nosocomial infections in high risk settings. The routine to recommend patients two or three double showers with CHX soap before clean surgery is well established but recently questioned. This update of our 2015 HTA report updates all parts except for background, intervention, objective, organisation and economy aspects. Objective: To assess whether preoperative chlorhexidine whole body wash is better than no chlorhexidine wash prior to clean surgery through intact skin regarding mortality, serious SSI (sSSI), SSI: usually infection including implants or septicaemia, reintervention and length of hospital stay.

Authors' results and conclusions: In this update, one RCT and two cohort studies were added. This resulted in a total of eight RCTs and five cohort studies and a novel conclusion that there may be a lower implant infection rate after preoperative CHX compared with soap wash in lower extremity total joint arthroplasty patients (GRADE ⊕⊕). It is uncertain whether there is any difference in the rate of sSSI after preoperative CHX versus “no instruction” (GRADE ⊕). Regarding SSI, preoperative CHX compared with placebo wash may result in a moderate decrease to a slight increase in SSI rate in mixed clean surgery patient populations (GRADE ⊕⊕), whereas the certainty of evidence is very low (GRADE ⊕) for all other comparisons.

Project Status: Completed

Year Published: 2020

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-750/native/HTA%20Update%20Chlorhexidine%20wash%20prior%20to%20clean%20surgical%20procedures%202020-03-23%20PUBLICERAD.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se