Chlorhexidine Showers are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries

Neurosurgery. 2019 Dec 1;85(6):817-826. doi: 10.1093/neuros/nyy568.


Background: Surgical site infection (SSI) is a common complication following spinal surgery. Prevention is critical to maintaining safe patient care and reducing additional costs associated with treatment.

Objective: To determine the efficacy of preoperative chlorhexidine (CHG) showers on SSI rates following fusion and nonfusion spine surgery.

Methods: A mandatory preoperative CHG shower protocol was implemented at our institution in November 2013. A cohort comparison of 4266 consecutive patients assessed differences in SSI rates for the pre- and postimplementation periods. Subgroup analysis was performed on the type of spinal surgery (eg, fusion vs nonfusion). Data represent all spine surgeries performed between April 2012 and April 2016.

Results: The overall mean SSI rate was 0.4%. There was no significant difference between the pre- (0.7%) and postimplementation periods (0.2%; P = .08). Subgroup analysis stratified by procedure type showed that the SSI rate for the nonfusion patients was significantly lower in the post- (0.1%) than the preimplementation group (0.7%; P = .02). There was no significant difference between SSI rates for the pre- (0.8%) and postimplementation groups (0.3%) for the fusion cohort (P = .21). In multivariate analysis, the implementation of preoperative CHG showers were associated with significantly decreased odds of SSI (odds ratio = 0.15, 95% confidence interval [0.03-0.55], P < .01).

Conclusion: This is the largest study investigating the efficacy of preoperative CHG showers on SSI following spinal surgery. In adjusted multivariate analysis, CHG showering was associated with a significant decrease in SSI following spinal surgery.

Keywords: Chlorhexidine; Fusion; Fusion surgery; Nonfusion; Nonfusion surgery; Spinal surgery; Surgical site infection.

MeSH terms

  • Adult
  • Chlorhexidine / administration & dosage*
  • Cohort Studies
  • Disinfectants / administration & dosage*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Reconstructive Surgical Procedures / adverse effects
  • Spinal Diseases / diagnosis
  • Spinal Diseases / surgery*
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / etiology*
  • Surgical Wound Infection / prevention & control*


  • Disinfectants
  • Chlorhexidine