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Decontamination of Nasopharynx and Oropharynx with Chlorhexidine Gluconate Appears to Reduce Nosocomial Infection After Cardiac Surgery

December 7, 2006

By Sahar Bedrood B.S. and Asher Kimchi M.D.

Amsterdam - Nosocomial infections after open-heart surgery is recognized as an important cause of complications and mortality. Patrique Segers, MD et al from the University of Amsterdam set out to determine the efficacy of perioperative decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate for reduction of nosocomial infection after cardiac surgery. Their study, published in the November 22/29 issue of the Journal of the American Medical Association found that decontamination with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery.

A prospective, randomized, double-blind, placebo-controlled clinical trial was conducted on 991 patients. The patients were administered either a 0.12% chlorhexidine gluconate solution or a placebo. The oropharyngeal solution was used as a mouth rinse and applied to the buccal, pharyngeal, gingival, and tooth surfaces for 30 seconds 4 times daily. The nose ointment was applied 4 times a day in both nostrils. The protocol was continued until the nasogastric tube was removed, usually the day after surgery. 

Staphylococcus aureus cultures of the nares were taken before randomization and at time of surgery. Additionally, incidence of nosocomial infection as well as rate of S aureus nasal carriage was monitored.

The incidence of nosocomial infection in the chlorhexidine gluconate group and placebo group was 19.8% and 26.2%, respectively (absolute risk reduction [ARR], 6.4%; 95% confidence interval [CI], 1.1%-11.7%; P = .002). In particular, lower respiratory tract infections and deep surgical site infections were less common in the chlorhexidine gluconate group than in the placebo group (ARR, 6.5%; 95% CI, 2.3%-10.7%; P = .002; and 3.2%; 95% CI, 0.9%-5.5%; P = .002, respectively). For the prevention of 1 nosocomial infection, 16 patients needed to be treated with chlorhexidine gluconate. A significant reduction of 57.5% in S aureus nasal carriage was found in the chlorhexidine gluconate group compared with a reduction of 18.1% in the placebo group (P<.001). Total hospital stay for patients treated with chlorhexidine gluconate was 9.5 days compared with 10.3 days in the placebo group (ARR, 0.8 days; 95% CI, 0.24-1.88; P = .04).

The study concluded that decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery.

Co-authors: Patrique Segers, MD; Ron G. H. Speekenbrink, PhD; Dirk T. Ubbink, PhD, Marc L. can Ogtrop, PhD, Bas A. de Mol, MD, PhD

 


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