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Effect of Preoperative Shampoos with Chlorhexidine or lodophor on Emergence of Resident Scalp Flora in Neurosurgery

Published online by Cambridge University Press:  02 January 2015

Jeanne M. Leclair ,
Ken R. Winston ,
Bernadette F. Sullivan ,
Janet M. O'Connell ,
Stella M. Harrington  and
Donald A. Goldmann
Jeanne M. Leclair*
Affiliation:
Infection Control Program and Departments of Nueorsurgery and Medicine, The Children's Hospital, Boston, Massachusetts
Ken R. Winston
Affiliation:
Infection Control Program and Departments of Nueorsurgery and Medicine, The Children's Hospital, Boston, Massachusetts
Bernadette F. Sullivan
Affiliation:
Infection Control Program and Departments of Nueorsurgery and Medicine, The Children's Hospital, Boston, Massachusetts
Janet M. O'Connell
Affiliation:
Infection Control Program and Departments of Nueorsurgery and Medicine, The Children's Hospital, Boston, Massachusetts
Stella M. Harrington
Affiliation:
Infection Control Program and Departments of Nueorsurgery and Medicine, The Children's Hospital, Boston, Massachusetts
Donald A. Goldmann
Affiliation:
Infection Control Program and Departments of Nueorsurgery and Medicine, The Children's Hospital, Boston, Massachusetts
*
Hospital Epidemiology Department, Brady #119, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21205
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Abstract

Wound contamination with endogenous bacterial scalp flora plays an important role in the pathogenesis of postoperative neurosurgical infections. To assess the effect of preoperative antiseptic shampoos on the emergence of resident scalp flora during surgery and subsequent wound contamination, we randomized 151 neurosurgical procedures into four study groups: group A—preoperative shampoos with chlorhexidine, surgical scalp preparation with chlorhexidine; group B-no shampoos, surgical preparation with chlorhexidine; group C-shampoos with iodophor, surgical preparation with iodophor; group D-no shampoos, surgical preparation with iodophor. Quantitative cultures of the scalp were obtained preoperatively and at the end of surgery, and qualitative wound cultures were taken prior to wound closure. Group A had the lowest concentration of bacteria on the scalp both preoperatively and postoperatively (median range = 30 [0-5.7 × 105] and 0 [0-2.5 x 103] respectively). Group A also had significantly fewer positive postoperative scalp cultures (29%) than groups B (51%), C (58%), and D (53%) (P<0.05), as well as fewer positive wound cultures (20% v 25%, 42%, and 30% respectively). A density of bacteria on the scalp of > 102/4cm2 best predicted the presence of bacteria in the wound. Repeated preoperative shampoos with chlorhexidine reduce intraoperative emergence of resident skin flora and subsequent contamination of the wound.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 9 , Issue 1 , January 1988 , pp. 8 - 12
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1988

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