Preoperative footbaths reduce bacterial colonization of the foot

Previous studies have demonstrated higher infection rates following elective procedures on the foot and ankle compared with procedures involving other areas of the body. Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery. The purpose of the present study was to ascertain if preoperative chlorhexidine bathing decreased the number of bacteria on the forefoot.

From October 2005 to October 2006, a prospective study was undertaken to evaluate 44 consecutive patients undergoing planned, elective surgery of the foot and ankle. (mean age, 43.9 years; range, 17 to 85 years; 25 female, 19 male). Twenty-two patients were assigned to each group. They were randomly assigned to have preoperative footbath with chlorhexidine gluconate (Hibitane) (Group 1) 20 minutes before surgery or placebo (Group 2). Culture swabs were taken from all web spaces, nail folds, toe surfaces and proposed surgical incision sites before the preoperative bath, during the procedure and immediately after surgery.

In Group 1, bacteria grew on the intraoperative culture in 60% and 0% of immediate postoperative cultures. In Group 2, 96% of intraoperative cultures and 16% of postoperative cultures. The difference in the intraoperative bacterial count was statistically significant (p = 0.002). The difference in postoperative bacterial counts was marginally significant (p = 0.055). No complications were recorded in either group.

These data indicate that chlorhexidine provides better reduction in skin flora than placebo. Based of these data, we recommend the use of a chlorhexidine footbath in addition to standard surgical preparatory agent before foot and ankle surgery.