Chlorhexidine Gluconate-Incised Surgical Drapes Seem More Effective

Plastic, adhesive incise drapes were introduced over 50 years ago as a way of cutting down on surgical site infections (SSIs), but in the last decade or so their efficacy in this regard has been questioned. Maybe it’s time to switch to chlorhexidine gluconate (CHG)-incised drapes to do that job, suggests a study in the American Journal of Infection Control.

“A novel surgical drape impregnated with CHG was effective in significantly reducing MRSA [methicillin resistant Staphylococcus aureus] contamination in an incisional wound model of contamination when compared with a nonantimicrobial drape or an iodophor impregnated drape,” the study states.

Anywhere from 2% to 4% of the approximately 10 million patients in the United States who undergo surgery come down with an SSI, the study states. The source of the contamination can be the patient’s skin, which is why patients are often prepared for surgery with antiseptic showers and skin antisepsis. However, recontamination can occur from bacteria hidden in deeper levels of skin and in hair follicles.

“Adhesive incise drapes have been used to theoretically prevent this, in combination with other draping techniques, by acting as a microbial barrier to prevent bacterial migration and contamination of the wound,” the study states. “The value of this practice is not without controversy, a 2015 Cochrane Collaborative concluded that: ‘there was no evidence to support the use of plastic, adhesive incise drapes as a method for reducing infection [SSI], and that there was some evidence that infection rates may actually increase when adhesive incise drapes are used.’”

Investigators also note that guidelines by the Centers for Disease Control and Prevention say that there exists no indication that iodophor-impregnated adhesive drapes offer patients any better protection than no drapes at all.

Investigators compared 3 different types of self-adhesive, surgical incise drapes: CHG, an antimicrobial incise drape containing an iodophor, and a non-antimicrobial incise drape containing an iodophor.

The subjects of the experiment were 12 female pigs, from 6 to 9 weeks old. The animals were divided into 3 groups of 4 pigs. In 1 group, the wounds were left open for an hour, and in another the wounds were left open for 4 hours. In the third group, the wounds were fixed almost immediately. The pigs were inoculated with MRSA.

“MRSA recovery from incisional wounds was lowest in sites treated with the CHG drape,” the study states. “The difference was statistically significant (P < .001) at all time points, both between the CHG drape and the nonantimicrobial control as well as between the CHG and iodophor drapes. Mean MRSA recovery from wounds treated with iodophor drapes was slightly lower than nonantimicrobial drapes.” And while “the difference was not statistically significant at 0- or 1-hour (P = .065 and P = .089, respectively)” the differences were significant at 4-hours after surgery.

The study states that “compared to iodophors, CHG is generally more persistent and better in maintaining efficacy in the presence of blood and organic material, introducing a new CHG-based option might well become an effective component of future SSI prevention bundles.”

There were study limitations. The study included CHG and alcohol skin prep, but did not include CHG bathing. And the study focused solely on MRSA, and it’s not known how the CHG drapes would fare against the many other deadly pathogens in circulation.

“Finally, clinical efficacy can only be assessed through randomized, controlled clinical trials in patients undergoing a wide range of surgical procedures,” the study states.