Chlorhexidine scrubbing (Figure 1)
Starting in 2017, institutional protocols for the management of CIED
infection allowed CHG scrubbing in lieu of complete capsulectomy. This
decision was based on the occurrence of hematomas requiring surgical
drainage after capsulectomy, and previous reports on the safety of CHG
use in wounds, even in delicate tissues such as the peritoneal
membrane.(14-17) Moreover, capsule removal is frequently avoided in the
treatment of infections in other sites where the extensive manipulation
of adjacent tissues (i.e., liver or brain tissue) can lead to
significant tissue damage.
After complete hardware removal, 20cc of 2% chlorhexidine soap was
introduced into the generator pocket, and gentle manual scrubbing (using
the index and middle fingers) of the entire cavity was performed for at
least 1 minute. Subsequently, exhaustive irrigation with approximately
500 cc of SNS was performed, and manual scrubbing within the generator
pocket was repeated. The pocket was dried using sterile gauze, and the
wound was closed with an absorbable interrupted intradermal suture (with
at least 1cm between suture points).