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Leclair JM, Winston KR, Sullivan BF, et al. Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery. Infect Control Hosp Epidemiol. 1988;9(1):8-12doi: 10.1086/645726.
Leclair, J. M., Winston, K. R., Sullivan, B. F., O'Connell, J. M., Harrington, S. M., & Goldmann, D. A. (1988). Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery. Infection control and hospital epidemiology, 9(1), 8-12. https://doi.org/10.1086/645726
Leclair, J M, et al. "Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery." Infection control and hospital epidemiology vol. 9,1 (1988): 8-12. doi: https://doi.org/10.1086/645726
Leclair JM, Winston KR, Sullivan BF, O'Connell JM, Harrington SM, Goldmann DA. Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery. Infect Control Hosp Epidemiol. 1988 Jan;9(1):8-12. doi: 10.1086/645726. PMID: 19722931.
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Infect Control Hosp Epidemiol. 1988 Jan;9(1):8-12. doi: 10.1086/645726.

Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery.

Infection control and hospital epidemiology

J M Leclair, K R Winston, B F Sullivan, J M O'Connell, S M Harrington, D A Goldmann

Affiliations

  1. Hospital Epidemiology Department, The Johns Hopkins Hospital, Baltimore, MD, USA.

PMID: 19722931 DOI: 10.1086/645726

Abstract

Wound contamination with endogenous bacterial scalp flora plays an important role in the pathogenesis of postoperative neurosurgical infections. To assess the effect of preoperative antiseptic shampoos on the emergence of resident scalp flora during surgery and subsequent wound contamination, we randomized 151 neurosurgical procedures into four study groups: group A-preoperative shampoos with chlorhexidine, surgical scalp preparation with chlorhexidine; group B-no shampoos, surgical preparation with chlorhexidine; group C-shampoos with iodophor, surgical preparation with iodophor; group D-no shampoos, surgical preparation with iodophor. Quantitative cultures of the scalp were obtained preoperatively and at the end of surgery, and qualitative wound cultures were taken prior to wound closure. Group A had the lowest concentration of bacteria on the scalp both preoperatively and postoperatively (median range = 30 [0-5.7 x 10(5)] and 0 [0-2.5 x 10(3)] respectively). Group A also had significantly fewer positive postoperative scalp cultures (29%) than groups B (51%), C (58%), and D (53%) (P<0.05), as well as fewer positive wound cultures (20% v 25%, 42%, and 30% respectively). A density of bacteria on the scalp of < 10(2)/4 cm(2) best predicted the presence of bacteria in the wound. Repeated preoperative shampoos with chlorhexidine reduce intraoperative emergence of resident skin flora and subsequent contamination of the wound.

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