Preoperative Chlorhexidine Bathing to Reduce Surgical Site Infections

Abstract

Introduction: Surgical site infections (SSI) occur in 2-5% of clean-contaminated surgeries. Preoperative chlorhexidine gluconate (CHG) bathing is widely recommended but recent trials question its benefit. Methods: Systematic review of 8 RCTs (n=16,872) comparing preoperative CHG bathing (2-4% solution, ≥1 shower) versus placebo or no bathing. Primary outcome: SSI within 30 days (CDC criteria). Secondary: adverse skin reactions. Results: Overall SSI rate was 4.1% (CHG) vs 4.6% (control) (RR 0.89, 95% CI 0.78-1.02, p=0.09). Subgroup analysis showed benefit only when CHG was combined with nasal mupirocin (RR 0.67, p=0.01) and in orthopedic surgery (RR 0.71, p=0.02). Skin reactions were rare (0.3%). Discussion: CHG bathing alone does not significantly reduce SSI. Its effect is small and likely overestimated in prior non-blinded trials. Combination decolonization protocols are more effective. Conclusion: Routine CHG bathing without nasal decolonization is not recommended. Hospitals should adopt bundled approaches for high-risk procedures.