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Role of Pre-operative Chlorhexidine Gluconate Baths and Wipes in Post-Operative Surgical Site Infection Prevention in Pediatric Urologic Inguinal and Scrotal Surgery
Claudia Berrondo, MD, Jennifer J. Ahn, MD, MS, Margarett Shnorhavorian, MD, MPH.
Seattle Children's Hospital, Seattle, WA, USA.

Title:
Role of Pre-operative Chlorhexidine Gluconate Baths and Wipes in Post-Operative Surgical Site Infection Prevention in Pediatric Urologic Inguinal and Scrotal Surgery
Authors:
Claudia Berrondo, MD Jennifer J. Ahn, MD, MS, Margarett Shnorhavorian, MD, MPH
Background:
To reduce surgical site infections (SSI), many institutions utilize chlorhexidine gluconate (CHG) baths and/or wipes for pre-operative antisepsis. CHG reduces bacterial colonization of the skin, but it is unclear whether this reduces SSI, and current guidelines from the American College of Surgeons (ACS), the Centers for Disease Control (CDC), and the World Health Organization (WHO) recommend against routine pre-operative bathing with CHG. There are several factors that increase the risk of SSI in adults, but there is limited understanding of these factors in pediatric patients. The primary objectives were to describe the proportion of pediatric patients undergoing hernia/hydrocele repair or orchiopexy who develop a post-operative (post-op) SSI, and to determine whether pre-operative CHG baths/wipes were associated with SSI. Our secondary objectives were to identify other factors associated with SSI, and to estimate the cost of CHG baths/wipes in this population.
Methods:
Pre-operative antisepsis with CHG baths/wipes was implemented at our institution in 2006. We performed a retrospective cohort study of patients 0-18 years of age undergoing hernia/hydrocele repair or orchiopexy by a pediatric urologist at our institution before (2004) and after (2008) the introduction of CHG. SSI was defined as documentation of infection of a surgical site in the patients' medical record. We compared the proportion of patients with SSI in the no CHG and CHG groups and evaluated for factors associated with SSI. Statistical analysis included Wilcoxon rank-sum test, chi-squared test, and Fisher's exact test. The cost of CHG baths and wipes was estimated using institutional fees in 2018 US dollars.
Results:
A total of 543 patients were included with 203 in the no CHG group and 340 in the CHG group. The overall proportion with post-operative SSI was 0.92%. There was no association between use of CHG and SSI (1% no CHG vs 1% CHG, p=0.9). No patient or peri-operative factors were associated with development of SSI (Table 1). There were no documented CHG-associated adverse events. The cost of materials was estimated at $3.29/patient ($1118.60 for 340 cases in 2008) in 2018 USD.
Conclusions:
SSI after hernia/hydrocele repair or orchiopexy in pediatric patients is uncommon. The use of pre-operative skin antisepsis with CHG baths and wipes was not associated with post-op SSI in this population and incurred added cost.
Table 1. Clinical characteristics by surgical site infection

Total (n=543)No SSI (n=538)SSI (n=5)p-value
Age in months (SD)61 (52)36 (38)62 (52)0.3
Sex
Male (%)
Female (%)
535 (99)
6 (1)
530 (99)
6 (1)
5 (100)
0 (0)
1
Tanner Stage
1 (%)
2 (%)
3 (%)
4 (%)
5 (%)
450 (83)
39 (7)
9 (2)
9 (2)
8 (2)
445 (83)
39 (7)
9 (2)
9 (2)
8 (2)
5 (100)
0 (0)
0 (0)
0 (0)
0 (0)
1
BMI (SD)19 (8)19 (8)20 (2)0.1
Comorbidities, n (%)
Developmental Delay
Seizures
Asthma
Cerebral palsy
Transplant
CKD
Diabetes
21 (4)
8 (2)
8 (2)
7 (1)
2 (0)
4 (1)
4 (1)
21 (4)
8 (2)
16 (3)
7 (1)
2 (0)
4 (1)
4 (1)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0.8
Surgery type, n (%)
Hernia/hydrocele
Orchiopexy
167 (31)
376 (69)
166 (31)
372 (69)
1 (20)
4 (80)
0.6

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