Retrospective analysis of operating room irrigation using a low concentration chlorhexidine gluconate (CHG) 0.05% in sterile water for infection prevention after foot & ankle surgery

Abstract

Surgical site infection (SSI) after foot and ankle procedures adversely impacts both the quality and cost of health care delivery; increasing hospital length of stay, the number of re-operations, and readmission rate(s). The purpose of the present study was to assess the incidence of SSI in patients who underwent foot and ankle surgery with concurrent intraoperative lavage containing low concentration Chlorhexidine Gluconate (CHG) 0.05% in sterile water, @Irrisept. Seventy-three patients underwent reconstructive foot and ankle procedures utilizing @Irrisept for intraoperative lavage between September 2020 and October 2021 at a single institution. Medical record and charts were reviewed and the incidence of complications including postoperative erythema, delayed wound healing, dehiscence, and superficial/deep SSI, as well as reoperations, was recorded. Minimum follow-up for inclusion was at least 90 days, and procedures with concurrent vancomycin powder or prophylactic antibiotics postoperatively were excluded. Twelve complications occurred in 73 patients (16%): 1 erythema (1.4%), 4 delayed wound healing (5.5%), 1 dehiscence (1.4%), and 6 SSI's (8.2%). Of the SSIs, 2 were superficial and 4 deep; incidence rate of 2.7 and 5.5%. Six reoperations were performed in 4 patients for deep SSI; 3 (75%) had a previously documented history of SSI after orthopedic surgery. A strong association was identified between previous SSI after orthopedic surgery and SSI of the foot and ankle (p = 0.000271). The data suggests a low incidence of deep SSI in patients without a documented history of previous SSI after orthopedic surgery. Additional studies are warranted to validate the potential association identified.