Preoperative Skin Disinfection Research Articles

Antiseptic Techniques in Breast Implant Surgery: Insights From Plastic Surgeons in Saudi Arabia.

Breast implant surgery is a popular procedure worldwide, and the same holds true for Saudi Arabia. Ensuring a sterile surgical environment is crucial to avert postoperative infections. This study explores the various antiseptic techniques adopted by Saudi plastic surgeons during breast implant procedures. This study aims to assess Saudi plastic surgeons' adherence to antiseptic measures in breast implant surgery, and determine what types of antiseptic measures are most commonly used among Saudi plastic surgeons. The authors conducted a cross-sectional survey among board-certified plastic surgeons in Saudi Arabia, collecting data through a self-administered online questionnaire. This questionnaire, which covered their demographic information and their antiseptic practices during breast implant surgery, was disseminated via a WhatsApp (Menlo Park, CA) broadcast message from May 15 to June 27, 2023. Of the 52 Saudi plastic surgeons who completed the questionnaire, all reported employing preoperative antibiotics and skin disinfection. Other measures included pocket irrigation (86.5%), implant irrigation (92.3%), sleeve/funnel usage (65.4%), nipple shield usage (51.9%), and glove change during the procedure (96.2%). Nearly, all respondents used only a surgical cap for head cover (96.2%) and postoperative antibiotics as prophylaxis (98.1%). However, more than half of them did not minimize door movement during the procedure (51.9%). This study offers a valuable insight into the antiseptic practices during breast implant surgery in Saudi Arabia. The findings underline the need for further research to establish evidence-based guidelines for antiseptic practices in this field.

Comparison of two different antiseptics regarding intracutaneous microbial load after preoperative skin cleansing in total knee and hip arthroplasties

Periprosthetic infections (PPIs) are a serious concern in total knee and hip arthroplasty, and they have an increasing incidence. To prevent PPI, preoperative skin disinfection, as a key element of antisepsis, represents an important part of infection prevention. However, no specific antiseptic agent is endorsed by the relevant guidelines. The purpose of this retrospective, not randomized study was to investigate the difference in the residual bacteria load between an approved antiseptic with an alcohol-based solution with additional benzalkonium chloride (BAC) and an alcohol-based solution with additional octenidine dihydrochloride (OCT) at two different time periods. In 200 consecutive patients with total knee or hip arthroplasty, skin samples from the surgical sites were collected after skin disinfection with BAC (100 g solution contain: propan-2-ol 63.0 g, benzalkonium chloride 0.025 g) or OCT (100 g solution contain: octenidine dihydrochloride 0.1 g, propan-1-ol, 30.0 g, propan-2-ol 45.0 g) (100 patients per group). Following the separation of cutis and subcutis and its processing, culture was performed on different agar plates in aerobic and anaerobic environments. In the case of bacteria detection, the microbial identification was determined by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS), and the number of contaminated samples was compared between the groups. Additionally, multiple regression analysis was performed to examine the effect of the type of disinfectant, BMI, age, sex, rheumatoid arthritis, diabetes mellitus, skin disorders, smoking status, and localization of skin samples on positive bacteria detection. A total of 34 samples were positive for bacteria in the BAC group, while only 17 samples were positive in the OCT group (p = 0.005). Disinfectant type was the only significant parameter in the multiple regression analysis (p = 0.006). A significantly higher contamination rate of the subcutis was shown in the BAC group compared to the OCT group (19 vs. 9, p = 0,003). After the change from BAC to OCT in preoperative skin cleansing in the hip and knee areas, the number of positive cultures decreased by 50%, which might have been caused by a higher microbicidal activity of OCT. Therefore, the use of OCT in preoperative cleansing may reduce the risk of PPI in hip and knee surgery. Randomized controlled trials are required to confirm the effect and to evaluate if it reduces the risk of PPI.

Preoperatif cilt antisepsisi için 2 farklı rejimin cerrahi alan enfeksiyon sonuçları: povidon-iyot ile tek katmana karşı povidon-iyot / oktenidin dihidroklorür ile çift katman

Aim: Surgical site infection (SSI) is a frequent complication following any surgery. SSI still one of the main causes of elongated hospitalization, morbidity, and cost charges despite the development of new techniques, new materials, and new procedures. This study aims to compare the postoperative outcomes concerning single or double-layer or disinfectant application.
 Material and Methods: This is a retrospective study aiming to inference the results of 2 different methods of preoperative skin disinfection after Lichtenstein tension-free open hernia repair with prolene mesh. A total of 298 patients enrolled in this study. This is a retrospective study comparing the outcomes of SSI open herniorrhaphy with prolene mesh.
 Results: Wound infection has occurred in 13 patients from Group-1 (%6.80) versus 3 patients on Group-2 (%2.80) respectively, which is statistically significantly lower than Group-1(p˂0.05).
 Conclusion: As our results showed, we suggest that octenidine dihydrochloride could be considered a powerful alternative to conventional disinfectant solutions, but further investigations with a single application of octenidine dihydrochloride are needed.

Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden

BackgroundThe saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients’ risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons.MethodsA national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden.ResultsResponses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons.Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound.Conventional technique was used by 78.6% of the surgeons, “no-touch” by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres.ConclusionsIn this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.

Number of Necessary Paints of Preoperative Skin Disinfection to Prevent Surgical Site Infections

Number of Necessary Paints of Preoperative Skin Disinfection to Prevent Surgical Site Infections

Surveillance of surgical site infections cases in prosthetic orthopedics in a French University Hospital, from 2013 to 2016

Introduction Surgical site infections (SSI) in prosthetic orthopedic surgery are infrequent but serious complications. They are responsible for repeated and prolonged hospitalizations, morbidity, and severe disabilities, which can be life-threatening and lead to high hospitalization costs. SSI incidence after total articular prosthesis is estimated between 0.5 and 6% in the United States and between 0.5 and 1% in Europe. In France, in 2015 SSI incidences after total hip arthroplasty (THA) and total knee arthroplasty (TKA) were 0.8% and 0.5%, respectively. The objective is to report SSI incidence trends and to describe SSI cases for patients hospitalized for THA and TKA in a Prosthetic Orthopedic Unit of Lyon University Hospital (LUH), from 2013 to 2016. Methods This surveillance was targeted to adult patients operated on for a scheduled or emergency surgery of THA and TKA in an Orthopedic and Traumatological Surgery Unit of Edouard-Herriot University Hospital (Lyon, France, 1160 beds), from January 1, 2013 to December 31, 2016. Patients’ follow-up lasted one year; all the cases of surgical revision in Orthopedic or Emergency Surgery Unit were identified and consulted, in order to check for a possible infectious reason. All SSI suspected cases were studied and evaluated in collegial discussion, after consultation of patient records, analysis of revision reasons and of bacteriological positive samples. SSI incidence was calculated by % cases/total population of patients operated on from 2013 to 2016 [95% confidence interval (95% CI) is indicated]. Results In total, from 2013 to 2016, 1497 patients have been operated on for arthroplasty (40.3% of TKA, 59.7% of THA); 60.7% of them were women, average age was 68.6 ± 14.4 years. ASA distribution was: 1 (9.5%), 2 (53.6%), 3 (34.7%), 4 (1.5%), 5 (0.1%). Average surgery duration was 105.1 ± 43.4 min (surgery duration Conclusions In our university hospital, SSI incidence on prosthetic orthopedics interventions (THA and TKA) from 2013 to 2015 maintained a nearly constant trend, higher than national level (national global incidence from 2013 to 2015: 0.6% [95% CI: 0.6–0.7)]. In 2016, SSI incidence on THA remained constant, while SSI incidence on TKA showed a threefold increase. SSI cases analysis indicated that they were all characterized by known patients (overweight or obesity, insulin-dependent diabetes or immunosuppressive therapies) or intervention risk factors (longer intervention duration). The most frequently identified microorganisms are of cutaneous origin, emphasizing the importance of preoperative preparation, including preoperative showers, depilation and skin disinfection. According to the “National Action Program for the Prevention of Healthcare-Associated Infections” (2015), the objective of SSI incidence on THA and TKA inferior or equal to 1% must be reached and maintained.

Evaluations for Lifting and Traction Forces of Low Extremities with Fracture

Preoperative skin sterilization, disinfection, and fracture reduction are all necessary for surgeries of the fractured lower extremity. This procedure requires several medical personnel, even though its tasks are relatively simple. Therefore, development of an assistant device for the preoperative disinfection and the simple fracture reduction is required as an alternative. To obtain the design specifications of the equipment, we evaluated lifting and traction forces using the lower extremities of Korean fresh cadavers. The lifting force was measured when each leg was lifted from the table using 39 Korean fresh cadavers. The same method was applied to measure the traction force on a femoral fracture model using 22 Korean fresh cadavers. The mean lifting force was 36.8 ± 11.8 N, and the mean traction force was 116.8 ± 37.9 N. Regression analysis yielded the following equations: lifting force = 0.6724*(body weight) - 0.8068, R2 = 0.71; traction force = 1.6880*(body weight) + 18.1495, R2 = 0.57. This study determined the lifting and traction forces, not just the body segment weights. These results will be helpful for developing medical assistant devices.

Comparative clinical effectiveness of preoperative skin antiseptic preparations of chlorhexidine gluconate and povidone iodine for preventing surgical site infections in dogs

Contamination of surgical sites often resulting from inadequate surgical site preparation and poor asepsis is a common cause of surgical site infection (SSI) and postoperative complications. Standard practice ensuring preoperative skin disinfection helps to prevent the incidence of SSI. The choice of antiseptic therefore poses a serious counterbalance for the surgeon. This study was carried out to determine whether skin asepsis immediately prior to surgical site incision will reduce skin microbial burden that may potentiate the incidence of SSI and to compare the clinical effectiveness of chlorhexidine gluconate B.P 0.3%W/V, Cetrimide B.P 3.05 W/V (CG + Cetrimide) against povidone iodine 10% (PI) in pre-surgical skin preparation and asepsis in dogs. A total of 15 dogs were used for the study. Both side of each dog was used for the study, right side for CG + Certrimide and left side for PI; (n = 30). Aseptic agents’ chlorhexidine gluconate 0.3% and Cetrimide 3.0% and povidine iodine 10% were used as pre surgical scrub solutions prior to surgery. Swab samples were evaluated before scrubbing, 0, 30, 60 and 90 min after scrubbing. Percent reductions of bacterial colony forming units were determined for all site scrub techniques. Mixed-design ANOVA results revealed significant difference (P < 0.05) within groups and no significant difference (P > 0.05) in the disinfectant effects between groups treated with CG + Cetrimide and povidone iodine respectively across the various time periods. Changes in the mean bacteria count were observed to be equivalent using CG + Cetrimide and povidone iodine. It was concluded that there was no significant difference between CG + Cetrimide and PI in preoperative surgical skin preparations.

Effect of chlorhexidine skin disinfection and retrosternal gentamicin sponge on post-sternotomy mediastinitis: results from a prospective controlled registry of 2340 patients

Reducing post-sternotomy mediastinitis (PSM) requires incorporating multiple methods. However, the independent effects of these measures are not well studied. To evaluate the independent effect of preoperative disinfection using isopropyl alcohol (IPA)-chlorhexidine gluconate (CHG) and the topical application of a retrosternal gentamicin collagen sponge at wound closure on reducing PSM. From October 2012 to August 2014, 2340 patients were included in this prospective, controlled registry. Patients were divided into four groups. In groups 1 and 2, the skin was disinfected with IPA, and in groups 3 and 4, the skin was disinfected with IPA-CHG. A retrosternal gentamicin collagen sponge was used in groups 2 and 4. Freedom from PSM up to the 30th postoperative day was the primary endpoint. The secondary endpoint was freedom from any surgical site dehiscence. A stepwise regression model was made to reveal the independent factors associated with lower incidence of PSM. There were significant differences in outcome among the groups (P<0.0001). Primary healing was highest in group 4 (91.4%), which showed the lowest rate for mediastinitis (0.9%). Multivariate analysis showed that the use of CHG and a gentamicin sponge was statistically significant (P=0.026 and 0.013, respectively). The other significant independent factors were valve operation (P=0.001), body mass index >30kg/m2 (P=0.001), preoperative stroke (P=0.005), and blood transfusion (P=0.022). Preoperative skin disinfection with IPA-CHG is superior to only IPA, and it should be recommended. The addition of a retrosternal gentamicin-releasing sponge further reduces the rate of mediastinitis.

Patients' experiences with at-home preoperative skin disinfection before elective hip replacement surgery.

The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery. Data were analysed with qualitative manifest content analysis according to Graneheim and Lundman (2004). The main categories of findings were: patients' experience of obstacles and limitations, the importance of supportive surroundings, and personal resources as strength when performing preoperative skin disinfection. The findings of this study agree with earlier studies showing a lack of compliance to preoperative skin disinfection. The findings also suggest reasons for non-compliance. Preoperative skin disinfection involves many important steps that need to be accomplished to ensure the maximum effect on microbial burden on skin surface. These steps can be difficult for some patient groups. Perioperative dialogue is one way to identify patients' individual needs and to help patients participate in the process. The study concludes that patients who carried out skin disinfection at home before surgery have a great responsibility to prepare themselves. The challenge for perioperative nurses who work with preoperative information is to identify and individually guide those patients who need extended support so that all patients with elective hip replacement surgery receive the same quality of care. Further research should focus on how caregivers discover individuals with extended needs and on identifying the kind of support that is effective to achieve optimal conditions for hip replacement surgery.

Reducing Mediastinitis after Sternotomy with Combined Chlorhexidine-Isopropyl Alcohol Skin Disinfection: Analysis of 3,000 Patients.

Reducing surgical site infections (SSI) following median sternotomy remains a challenge for cardiac surgeons. Standard prophylaxis of SSI at our institution includes pre-operative skin disinfection with isopropyl alcohol (IPA). The addition of chlorhexidine gluconate (CHG) has the theoretical advantage of longer antimicrobial activity (>48h), compared with 2 h for IPA alone. This prospective registry study was conducted to evaluate the effect of combined CHG-IPA (ChloraPrep®) skin antiseptic on the incidence of sternal surgical incision infections after cardiac surgical procedures via median sternotomy. Between September 2011 and November 2013, 3,942 consecutive patients underwent cardiac surgery with median sternotomy at our institution. Among them, 2,985 patients met inclusion criteria and were enrolled in the study. The complete cohort was prospectively divided into two registries. In registry 1 (1,523 patients), CHG-IPA was used to disinfect skin at the thoracic operative site prior to incision. In registry 2 (1,462 patients), single IPA disinfection was used. The primary endpoint was the incidence of post-sternotomy mediastinitis within 30 d of surgery. Secondary endpoints were SSI of any other kind, 30-d survival, and hospital length of stay. Both registries were well matched in baseline characteristics and main risk factors. Post-operative data analysis revealed reduction in the rate of post-sternotomy mediastinitis in registry 1 (29 patients, 1.9%) versus registry 2 (62 patients, 4.2%), p = 0.0002. No relevant difference in incidence of other surgical site infections, length of hospital stay, and 30-d mortality was found. Skin disinfection with combined chlorhexidine-isopropyl alcohol reduced the incidence of mediastinitis in elective adult cardiac surgery with median sternotomy but did not affect other types of surgical site infections.

Positive impact on heat loss and patient experience of preheated skin disinfection: a randomised controlled trial.

The aim of this study was to compare the effect of preheated (36°C) and room-temperature (20°C) skin disinfectant solution on skin temperature and patients' experience of the skin disinfection process. To prevent surgical site infections, it is important to disinfect skin prior to invasive surgery. In clinical practice, conscious patients often comment on the coldness of the preoperative skin disinfection solution. Evidence is lacking, as to whether preheated skin disinfectant has any positive effects during preoperative skin disinfection. Randomised controlled trial. A total of 220 patients undergoing pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronisation therapy under local anaesthesia were included and randomly allocated to preheated or room-temperature skin disinfection. Skin temperature was assessed before and after skin disinfection at the planned incision site; in addition, three study-specific questions were used to assess how patients experienced the temperature. Patients experienced the skin disinfection process with preheated disinfectant as significantly more pleasant. They felt less cold and reported increased satisfaction with the temperature of the solution compared to patients who were disinfected with room-temperature solution. Skin disinfection with preheated solution also yielded a significantly higher mean skin temperature compared to room-temperature solution. Preoperative skin disinfection with preheated disinfectant may prevent heat loss and contributes to a more pleasant experience for patients. Skin disinfection with preheated skin disinfectant is an easy and inexpensive nursing intervention that has a positive impact on heat loss and on patients' experience of the disinfection process.

Preoperative Skin Disinfection Methodologies for Reducing Prosthetic Joint Infections

Surgical site infections following lower extremity total joint arthroplasty procedures remain a substantial economic burden to the patient, the treating institution, and the health care system. The complexity of these surgical procedures creates the potential for various patient- or surgery-related risk factors for infection. Although there is much literature regarding the use of many preventative methods, a consensus regarding the true efficacy and application of such practices is generally not available. In this review, we reviewed the preoperative skin disinfection methodologies that have been used for reducing periprosthetic infections following lower extremity total joint arthroplasty. Currently, cumulative evidence suggests that preoperative chlorhexidine baths or chlorhexidine-impregnated wipes may reduce the colonization of pathogenic organisms on the skin. In addition, multiple showers or topical applications of chlorhexidine may lead to more substantial reduction in colony counts. Advanced preoperative whole-body cleaning with chlorhexidine-containing cloths rather than site-specific application may confer additional advantages. Further randomized controlled trials with carefully planned protocols and endpoints are needed to determine if this conclusively leads to reduction in the rate of surgical site infections.

Sternal surgical site infection prevention – is there any room for improvement?

The objectives of this multicenter study are to evaluate current clinical practices in cardiac surgery concerning the prevention and management of sternal wound infections, to identify room for improvement, and to support implementation of systematic measures. As a part of a campaign for infection prevention in cardiac surgery in Germany, a multiple-choice questionnaire with two main sections was developed and submitted to all cardiac surgery units in Germany (79). The project was realized in cooperation with the German Society for Thoracic and Cardiovascular Surgery, the BQS Institute for Quality and Patient Safety, and the National Reference Center for Nosocomial Infection Surveillance. A representative number (54 of 79 or 68%) of German cardiac surgery centers participated in the survey, in which heterogeneous procedures and various standards for prevention were observed. Surveillance, standards, and advanced training regarding hygiene measures are present in almost all participating hospitals. Methicillin-resistant Streptococcus aureus (MRSA) screening is performed in 81.5% (44/54) of all participating departments. A little less than one-tenth (7.4%) perform decolonization measures on all patients, while 85.2% perform decolonization measures only on MRSA-positive patients. Application of perioperative antibiotic prophylaxis ranges from single-shot application to 3 days of treatment. Longer treatment is expensive and time-intensive, and also increases the risk of Clostridium difficile-associated diarrhea. Nearly three-quarters (70.4%) of all participating hospitals perform preoperative hair removal 1 day before surgery. Common techniques are clipping machines (53.7%), razors (40.7%), clipping machines and depilatory cream (1.9%), or depilatory cream only (1.9%). Remanent (37.0%) and non-remanent disinfectants (55.6%) are used for preoperative skin disinfection. The time of the first wound-dressing change varies from the day of surgery (1.9%) over the first (42.6%) or second (46.3%) day after surgery to up to 3 or more days after surgery (9.3%). The results of the evaluation show that basic measures for infection prevention in cardiac surgery in Germany are well implemented. Nevertheless, a relevant heterogeneity in the use of special measures was observed, although research-based guidelines for infection prevention in surgery do exist and many studies have demonstrated the usefulness and feasibility of these measures.

Surgical Preparation Solutions and Preoperative Skin Disinfection

Surgical Preparation Solutions and Preoperative Skin Disinfection

Preoperative skin disinfection.

Journal Article Preoperative skin disinfection Get access J Ghosh, J Ghosh Burns and Plastic Surgery Unit Search for other works by this author on: Oxford Academic Google Scholar D O Maisels, D O Maisels Burns and Plastic Surgery Unit Search for other works by this author on: Oxford Academic Google Scholar A S Woodcock A S Woodcock Department of Pathology, Whiston Hospital, Prescot, Lancashire Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 54, Issue 6, June 1967, Pages 551–553, https://doi.org/10.1002/bjs.1800540612 Published: 06 December 2005

The Impact of Preoperative Skin Disinfection on Preventing Intraoperative Wound Contamination

Abstract The efficacy of total body showering and incision site scrub with disinfectant agents was evaluated in a randomized, prospective study of 575 patients undergoing selected surgical procedures. Patients who showered twice with 4% chlorhexidine gluconate had lower mean colony counts of skin bacteria at the surgical incision site in the operating room prior to the final scrub than patients who showered twice with povidone-iodine solution or medicated bar soap. Patients in the chlorhexidine group had no growth on 43% of the incision site skin cultures compared with 16% in the povidone-iodine group and 6% in the soap and water group. Patients who showered and who were scrubbed with chlorhexidine also had lower rates of intraoperative wound contamination. Bacteria were recovered from the wounds of 4% of patients using this regimen compared with 9% for patients who used povidone-iodine and 15% for patients who showered with medicated soap and water and were scrubbed with povidone-iodine. We noted no difference in surgery-specific infection rates among patients in the three treatment groups; however, our sample sizes were too small to evaluate this outcome parameter adequately. These data suggest that preoperative showering and scrubbing with chlorhexidine is an effective regimen to reduce extrinsic intraoperative contamination of the surgical wound from skin bacteria. The efficacy of this regimen to prevent postoperative wound infection needs to be evaluated in a well-designed, carefully controlled prospective trial with adequate numbers of patients to achieve statistically valid conclusions.

The Impact of Preoperative Skin Disinfection on Preventing Intraoperative Wound Contamination

The Impact of Preoperative Skin Disinfection on Preventing Intraoperative Wound Contamination

New methods for determining pre-operative and postoperative skin disinfection

A comparison was made of the Thran pressurized spray gun and scrubbing with cotton swabs on the removal of organisms from the skin. Both methods showed similar results but sometimes considerable differences in counts were found on adjacent skin areas. The cotton swab method was used to compare the effect of 60 or 70% isopropanol and 10% povidone-iodine on the flora of the outer side of the upper arm over 24 h. With the exception of one test person, no significant difference was found between the disinfectants.

Cochlear damage from chlorhexidine in guinea pigs.

The disinfectant chlorhexidine has been extensively used as preoperative skin sterilizing agent. In the early 1970s it was suspected from clinical experience that inner ear damage with deafness might result from chlorhexidine accidentally introduced into the middle ear during preoperative skin disinfection. In order to study if chlorhexidine by local application in the middle ear has any ototoxic effect resulting in morphological changes in the organ of Corti, the tympanic cavity of guinea pigs was exposed to two different concentrations of the substance. Two different solvents were used and the duration of exposure was varied. The animals were sacrificed 2, 3, 4 or 10 weeks after exposure. In surface preparations of the organ of Corti, damage was seen in almost all exposed ears, related in extent to the concentration of chlorhexidine, the duration of exposure, and the time lapse after exposure. Furthermore, it was found that inner ear damage often extended beyond the organ of Corti and pathological changes were also observed in the mucosal lining of the tympanic cavity.