TABLE III.

Effectiveness of Preoperative Bathing with 2% Chlorhexidine Wipes in Reducing Surgical Site Infections After Total Hip or Knee Arthroplasty When Used as Monotherapy^*

Study	Study Type	Surgical Population	Protocol	Results	Conclusion
Kapadia et al.58 (2013)	Retrospective, observational, Level-III evidence	2545 THAs including 557 with CHG, 87 partially compliant with CHG, and 1901 without CHG	Application sites: head and neck, both arms, both legs, surgical site; two applications: evening before and morning of surgery	3 (0.5%) in treatment cohort vs. 32 (1.7%) in untreated cohort had deep SSIs (p = 0.0428)	Chlorhexidine wipes are effective as monotherapy in reducing deep SSIs in THA. Study limited by retrospective and observational nature.
Johnson et al.59 (2013)	Retrospective, observational, Level-III evidence	2293 TKAs including 478 with CHG, 80 partially compliant with CHG, and 1735 without CHG	Application sites: head and neck, both arms, both legs, and surgical site; two applications: evening before and morning of surgery	3 (0.6%) in treatment group vs. 38 (2.2%) in untreated cohort had deep SSIs (p = 0.0212)	Chlorhexidine wipes effective as monotherapy in reducing deep SSIs in THA. Study limited by retrospective and observational nature.
Farber et al.60 (2013)	Retrospective cohort, Level-III evidence	1660 THAs (845 with CHG and 815 without CHG) and 2055 TKAs (1046 with CHG and 1009 without CHG)	Application sites: THA—middle of femur to iliac crest circumferentially around involved leg; TKA—middle of tibia to middle of femur circumferentially around involved leg; one application at 1 hr before surgery	18 (1%) of all 1891 CHG-treated TJAs vs. 24 (1.3%) of 1824 untreated TJAs developed deep SSIs (p = 0.294); 10 (1.2%) of 845 CHG-treated THAs vs. 12 (1.5%) of 815 untreated THAs developed deep SSIs (p = 0.607); 8 (0.8%) of 1046 CHG-treated TKAs vs. 12 (1.2%) of 1009 untreated TKAs developed deep SSIs (p = 0.327)	Chlorhexidine wipes are not as effective as monotherapy in reducing SSI rates in THA and TKA. Study limited by retrospective design. Protocol did not include application of chlorhexidine wipes to extra-anatomic sites other than planned surgical site.

^*THA = total hip arthroplasty, CHG = chlorhexidine gluconate, SSI = surgical site infection, TKA = total knee arthroplasty, and TJA = total joint arthroplasty.