Pre-operative Skin Antisepsis with Chlorhexidine Gluconate Baths and Wipes Does Not Prevent Post-Operative Surgical Site Infection in Outpatient Pediatric Urologic Inguinal and Scrotal Surgery

Summary Introduction To reduce surgical site infections (SSI), many institutions utilize pre-operative antisepsis with chlorhexidine gluconate (CHG) baths and/or wipes. 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) do not support this practice. There are several factors that increase the risk of SSI in adults, but there is limited understanding of these factors in pediatric patients. Objectives 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. Study Design 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. 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 met inclusion criteria; 203 in the no CHG group and 340 in the CHG group. The overall rate of SSI was 0.92%. There was no association between use of CHG and SSI. No patient or peri-operative factors were associated with development of SSI. There were no CHG-associated adverse events. The cost of materials was estimated at $3.29/patient ($1118.60 for 340 cases in 2008) in 2018 US dollars. Discussion SSI is not common in pediatric patients undergoing hernia/hydrocele repair or orchiopexy. In our study, pre-operative antisepsis with CHG baths/wipes is not associated with a reduction in SSI and carries additional cost. Conclusions To our knowledge, this is the first study to evaluate the use of pre-operative antisepsis with CHG baths/wipes in an exclusively pediatric population. In our study, CHG baths/wipes add cost with no clear benefit for reducing SSI in pediatric patients undergoing hernia/hydrocele repair or orchiopexy.