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).