{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T11:00:36Z","timestamp":1772103636412,"version":"3.50.1"},"reference-count":64,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Paul Hartmann AG, 89522 Heidenheim, Germany"},{"name":"the independent agency Ma.CRO Lifescience Srl, 00187 Roma, Italy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Surgical site infections (SSIs) and prosthetic joint infections remain among the most serious complications in orthopedic surgery, and chemical debridement is recommended for all septic revisions. The combination of polyhexanide (PHMB) and poloxamer (PLX), with in vitro antimicrobial and antibiofilm activity, represents a promising antiseptic solution. An Italian Delphi consensus was conducted to define the indications and clinical applications of PHMB\/PLX as an antiseptic solution. Materials and Methods: A steering committee convened a panel of orthopedic surgeons, infectious disease specialists, and wound care specialists with expertise in musculoskeletal infections. A modified three-phase Delphi process was conducted. Twelve clinical questions and four outcome measures were developed through literature review and iterative discussion. Two Delphi rounds were conducted using a 9-point Likert scale, and statements were rated according to the GRADE method. Results: Twelve statements were developed, and all achieved strong consensus after two Delphi rounds. The panel identified key patient-related risk factors (smoking, diabetes, obesity, immunosuppression) and procedure-related risks (open fractures, primary\/revision arthroplasty, prolonged operative time). Antiseptic irrigation was considered superior to saline, and PHMB-PLX was considered potentially useful based on expert opinion as an addition to mechanical debridement given its antibiofilm activity and good cytocompatibility. Low-pressure irrigation and short exposure times are the preferred application methods, while avoiding use on cartilage or neural tissues. Conclusions: The Delphi panel reached strong consensus supporting the intraoperative use of PHMB-PLX due to its potential as an antiseptic adjunct, supported by expert consensus and translational evidence for preventing and treating SSIs in orthopedic surgery. The panel recommended conducting high-quality clinical research to verify these findings and improve standardized irrigation protocols.<\/jats:p>","DOI":"10.3390\/jcm15051718","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T16:58:18Z","timestamp":1771952298000},"page":"1718","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevention and Treatment of Surgical Site Infections in Orthopaedic Surgery: An Italian Delphi Consensus on Risk Stratification and Wound Irrigation Strategies"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4752-8027","authenticated-orcid":false,"given":"Pier Francesco","family":"Indelli","sequence":"first","affiliation":[{"name":"S\u00fcdtiroler Sanit\u00e4tsbetrieb, 39042 Brixen, Italy"},{"name":"The Breyer Center for Overseas Studies, Stanford University in Florence, 50125 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6182-9870","authenticated-orcid":false,"given":"Massimiliano","family":"De Paolis","sequence":"additional","affiliation":[{"name":"Unit\u00e0 di Ortopedia e Traumatologia Ospedale S. Orsola, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3621-1761","authenticated-orcid":false,"given":"Arcangelo","family":"Russo","sequence":"additional","affiliation":[{"name":"UOC Ortopedia e Traumatologia Ospedale Umberto I, Universit\u00e0 Kore di Enna, 94100 Enna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6913-8460","authenticated-orcid":false,"given":"Massimo","family":"Fantoni","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augusto","family":"Palermo","sequence":"additional","affiliation":[{"name":"Chirurgia Protesica Anca e Ginocchio di Humanitas Gavazzeni Bergamo, 24125 Bergamo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3493-8019","authenticated-orcid":false,"given":"Giovanni","family":"Pomponio","sequence":"additional","affiliation":[{"name":"Clinica Medica, Ospedali Riuniti di Ancona, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9198-4943","authenticated-orcid":false,"given":"Alessandro","family":"Scalise","sequence":"additional","affiliation":[{"name":"Clinica di Chirurgia Plastica e Ricostruttiva, Dipartimento di Medicina Sperimentale e Clinica, Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Politecnica delle Marche, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Tigani","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Ortopedia e Traumatologia dell\u2019Ospedale Maggiore di Bologna, 40133 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Violante","sequence":"additional","affiliation":[{"name":"Dipartimento di Ortopedia Centro di Alta Specialit\u00e0 di Chirurgia Protesica del Ginocchio e dell\u2019Anca e Traumatologia dell\u2019Ospedale Fatebenefratelli Isola Tiberina Gemelli di Roma, 00186 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7752-5935","authenticated-orcid":false,"given":"Steven L.","family":"Percival","sequence":"additional","affiliation":[{"name":"Biofilm Centre, 5D Health Protection Group Limited, Liverpool L7 8XZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9318-4114","authenticated-orcid":false,"given":"Biagio","family":"Zampogna","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico Di Roma, 00128 Rome, Italy"},{"name":"BIOMORF Department of Biomedical, Dental, Morphological and Functional Images, University of Messina, Department of Orthopaedic and Trauma Surgery, A.O.U. Policlinico \u201cG.Martino\u201d, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1264-0008","authenticated-orcid":false,"given":"Pierluigi","family":"Viale","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa di Malattie Infettive, Ospedale Sant\u2019 Orsola, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40128 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Foux, L., Szwarcensztein, K., Panes, A., Schmidt, A., Herquelot, E., Galvain, T., and Phan Thanh, T.N. (2025). Clinical and economic burden of surgical site infections following selected surgeries in France. 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