Abstract
Background
Dilute chlorhexidine gluconate (CHG) in sterile water is an antiseptic solution approved for intraoperative wound irrigation by the United States Food and Drug Administration. In practice, however, CHG is commonly diluted with normal saline, which can result in its precipitation potentially reducing the antimicrobial effect. The purpose of this study was to determine if the antimicrobial properties of CHG are reduced after dilution with normal saline compared to sterile water.
Materials and methods
Sterile paper disks were placed into undiluted 4% CHG (positive control), 0.05% CHG in sterile water, 0.05% CHG in normal saline, or normal saline alone (negative control) and then placed in triplicate onto the agar plates inoculated with Staphylococcus aureus. After incubating at 37 °C for 24 h, the diameter of the zone of inhibition around each disk was measured.
Results
The mean zone of inhibition for 4% CHG, 0.05% CHG in sterile water, 0.05% CHG in normal saline, and normal saline alone was 24 ± 0.6 mm, 16 ± 0.9 mm, 14 ± 0.5 mm, and 0 ± 0 mm, respectively (p < 0.01). The zone of inhibition for dilute CHG in normal saline was on average 2.5 mm less (95% CI 1.7–3.2 mm) than that of CHG in sterile water.
Conclusions
Dilute CHG in normal saline, versus sterile water, retained its antimicrobial activity with a small reduction in the zone of inhibition. Surgeons and scientists should be aware of the interaction between normal saline and CHG. Future scientific studies need to control for what solution is used for dilution.
Similar content being viewed by others
References
Barnes S, Spencer M, Graham D, Johnson HB (2014) Surgical wound irrigation: a call for evidence-based standardization of practice. Am J Infect Control 42(5):525–529. https://doi.org/10.1016/j.ajic.2014.01.012
van Meurs SJ, Gawlitta D, Heemstra KA, Poolman RW, Vogely HC, Kruyt MC (2014) Selection of an optimal antiseptic solution for intraoperative irrigation. J Bone Jt Surg 96(4):285–291. https://doi.org/10.2106/JBJS.M.00313
Edmiston CE, Bruden B, Rucinski MC, Henen C, Graham MB, Lewis BL (2013) Reducing the risk of surgical site infections: does chlorhexidine gluconate provide a risk reduction benefit? Am J Infect Control 41(5):S49–S55. https://doi.org/10.1016/j.ajic.2012.10.030
FLOW Investigators, Bhandari M, Jeray KJ et al (2015) A trial of wound irrigation in the initial management of open fracture wounds. N Engl J Med 373(27):2629–2641. https://doi.org/10.1056/NEJMoa1508502
Prado M, Santos Júnior HM, Rezende CM et al (2013) Interactions between irrigants commonly used in endodontic practice: a chemical analysis. J Endod 39(4):505–510. https://doi.org/10.1016/j.joen.2012.11.050
Bajaj TI, Loh C, Borgstrom D (2014) diluting chlorhexidine gluconate: one scrub or two? Surg Infect (Larchmt) 15(5):544–547. https://doi.org/10.1089/sur.2012.120
Hsieh C-S, Cheng H-C, Lin J-S, Kuo S-J, Chen Y-L (2014) Effect of 4% chlorhexidine gluconate predisinfection skin scrub prior to hepatectomy: a double-blinded, randomized control study. Int Surg 99(6):787–794. https://doi.org/10.9738/INTSURG-D-13-00179.1
Shams WE, Hanley GA, Orvik A, Lewis N, Shurbaji MS (2015) Peritoneal lavage using chlorhexidine gluconate at the end of colon surgery reduces postoperative intra-abdominal infection in mice. J Surg Res 195(1):121–127. https://doi.org/10.1016/j.jss.2015.01.030
Bondar VM, Rago C, Cottone FJ, Wilkerson DK, Riggs J (2000) Chlorhexidine lavage in the treatment of experimental intra-abdominal infection. Arch Surg 135(3):309–314
Ruder JA, Springer BD (2017) Treatment of periprosthetic joint infection using antimicrobials: dilute povidone-iodine lavage. J Bone Jt Infect 2(1):10–14. https://doi.org/10.7150/jbji.16448
Penn-Barwell JG, Murray CK, Wenke JC (2012) Comparison of the antimicrobial effect of chlorhexidine and saline for irrigating a contaminated open fracture model. J Orthop Trauma 26(12):728–732. https://doi.org/10.1097/BOT.0b013e31826c19c4
Acknowledgements
Special thanks to Sara Giddins, for her assistance in preparation and execution of the microbial experiments, and to Dr. Connie Price, for the use of her microbiology laboratory.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
All authors made contributions to the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article or revising it, and gave final approval of the submitted version.
Corresponding author
Ethics declarations
Conflict of interest
None of the authors have financial conflicts of interest relevant to the content of this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Vintimilla, D.R., Chambers, L., Mauffrey, C. et al. Just add water? Chlorhexidine’s antimicrobial properties are minimally affected by dilution in saline compared to water. Eur J Orthop Surg Traumatol 30, 613–615 (2020). https://doi.org/10.1007/s00590-019-02609-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-019-02609-x