Complications - Infection
A Chlorhexidine Solution Reduces Aerobic Organism Growth in Operative Splash Basins in a Randomized Controlled Trial

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Abstract

Background

Despite recommendations against the use of splash basins, due to the potential of bacterial contamination, our observation has been that they continue to be used in operating theaters. In hopes of decontaminating the splash basin, we sought to determine if the addition of chlorhexidine gluconate (CHG) would eliminate aerobic bacterial growth within the splash basin.

Methods

After Institutional Review Board approval, we began enrollment in a randomized controlled trial comparing 2 splash basin solutions. Splash basins (n = 111) were randomized to either the standard of care (control) solution of sterile water or the experimental solution containing 0.05% CHG. One 20 mL aliquot was taken from the basin at the end of the surgical case and delivered to an independent laboratory. Samples were plated on tryptic soy agar (medium) and incubated at 30°C-35°C to encourage growth. After 48-72 hours, the agar plates were examined for growth and a standard plate count of aerobic cultures was performed.

Results

The sterile water group was found to have bacterial growth in 9% of samples compared to no growth in the CHG group (P = .045). The organisms included Micrococcus luteus, Staphylococcus hominis, Gram-variable coccobacilli, and unidentifiable Gram-positive rods.

Conclusion

Given the safety and efficacy of a concentration of 0.05% CHG in reducing the bacterial contamination in the operative splash basin, it would seem that if the practice of using a splash basin in the operating theater is to be continued, the addition of an antiseptic solution such as that studied here should be considered.

Section snippets

Materials and Methods

After obtaining institutional review board approval (IRB# 76754, NCT# 02434510, https://clinicaltrials.gov/ct2/show/NCT02434510?term=Gililland&rank=2) we began enrollment in a randomized controlled trial comparing 2 splash basin solutions. Enrollment occurred between April and October 2015 at a single academic medical center. Our current protocol includes the use of a splash basin at the back table during all surgical cases. All planned cases of primary TKA or THA during this time period were

Results

Nine percent (95% confidence interval [CI] 2-20) of splash basins (Table 2) in the SW group were found to have bacterial growth compared to no growth (95% CI 0-7) in the CHG group (P = .045). The organisms identified included one basin with Micrococcus luteus, one with Staphylococcus hominis, one with Gram-variable coccobacilli, and one basin that had “unidentifiable” Gram-positive rods. There was no difference (P > .99) in growth between basins from THA cases (2/41, 5%) compared to basins from

Discussion

The complication of periprosthetic joint infection in the setting of hip or knee arthroplasty is associated with significant distress to the patient and surgeon as well as substantial financial burden to the healthcare system. As the movement toward accountable care organizations and bundled payments becomes more prominent, there will be increasing incentive to minimize complications. Whyte et al [9] demonstrated that as much as 70% of all bacteria contaminate the surgical wound via the hands

Conclusions

In conclusion, when operative splash basins are used, treatment of the basin with an antiseptic solution of 0.05% CHG in SW appears to be an effective way of eliminating bacterial growth. While we are unable to correlate contamination of splash basins with clinical infection after arthroplasty using splash basins, we feel that attempts to eliminate any possible source of bacterial contamination should be considered.

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.08.017.

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