ORTHOPEDICS THIS WEEK
VOLUME 13, ISSUE 38 | DECEMBER 5, 2017
4
Combining Antiseptics May Be Toxic; THA Patient
Mortality Risks; Troy Wilde, DPM Joins OrthoArizona
BY ELIZABETH HOFHEINZ, M.P.H., M.ED.
C
ombining Antiseptics May Be
Toxic Researchers from Stanford
University have undertaken a novel
line of study, namely investigating the
dangers of using multiple antiseptics
to irrigate a wound. Their work, “Anti-
septics Commonly Used in Total Joint
Arthroplasty Interact and May Form
Toxic Products,” appears in the Octo-
ber 25, 2017 edition of The Journal of
Arthroplasty.
Sean T. Campbell, M.D., department of
orthopaedic surgery at Stanford Uni-
versity and study co-author told OTW,
“We became interested in this topic
when the senior author noticed that a
basin with residues from one antisep-
tic was filled with another antiseptic on
the back table during an operation for
infection. A visible reaction occurred
between the two antiseptics in the basin
with creation of a precipitate.”
“We were not aware of this reac-
tion being described elsewhere in the
arthroplasty or orthopaedics literature
and felt that this chemical interaction
was important to investigate and report
as surgeons sometimes use multiple
antiseptics when treating infected joint
replacements. We then broadened the
scope by investigating the interactions
of various commonly used antiseptics.”
“We combined the various antiseptics
in all possible configurations in test
tubes. It turns out that antiseptics are
highly reactive chemicals. This is what
contributes to their efficacy. We were
surprised by how many of the solutions
visibly reacted when combined.”
Photo creation by RRY Publications, LLC
The authors wrote, “4% Chlorhexidine
gluconate (CHX), 0.5% Sodium Hypo-
chlorite (NaOCI), 3% hydrogen perox-
ide (HO), and 10% provideon-iodine
(BTD) solutions were obtained and all
possible combinations were mixed…” gen peroxide. Our literature review
revealed that these mixtures may be
creating products that are toxic. Final
determination of this, however, would
have to be the subject of more detailed
chemical analysis and research.”
Dr. Campbell commented to OTW, “We
found that an obvious, visible chemi-
cal reaction occurred with five of the
six antiseptic combinations tested. We
did not independently analyze or char-
acterize the details of the actual chemi-
cal reactions that occurred as this was
beyond our capabilities, and it is pos-
sible that even the final combination
resulted in a reaction that was not vis-
ible to us.” “The most important takeaway from
this work is that surgeons should not
concurrently use multiple antiseptics
to irrigate a wound as they are likely
to react and can potentially create toxic
compounds with unknown conse-
quences.”
“It may be that the most important
interactions involve Dakin’s solution
with either chlorhexidine or hydro-
THA Patients With Joint Infection
Have 2x Mortality Risk “Increased
Mortality After Prosthetic Joint Infec-
tion in Primary THA,” was published
in the November 2017 edition of Clini-
cal Orthopaedics and Related Research.
Per Hviid Gundtoft, Ph.D., researcher
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