 |
|
Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate
A Randomized Controlled Trial
Patrique Segers, MD;
Ron G. H. Speekenbrink, PhD;
Dirk T. Ubbink, PhD;
Marc L. van Ogtrop, PhD;
Bas A. de Mol, MD, PhD
JAMA. 2006;296:2460-2466.
Context Nosocomial infections are an important cause of morbidity and mortality after cardiac surgery. Decolonization of endogenous potential pathogenic microorganisms is important in the prevention of nosocomial infections.
Objective To determine the efficacy of perioperative decontamination of the nasopharynx and oropharynx with 0.12% chlorhexidine gluconate for reduction of nosocomial infection after cardiac surgery.
Design, Setting, and Participants A prospective, randomized, double-blind, placebo-controlled clinical trial conducted at the Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands, between August 1, 2003, and September 1, 2005. Of 991 patients older than 18 years undergoing elective cardiothoracic surgery during the study interval, 954 were eligible for analysis.
Intervention Oropharyngeal rinse and nasal ointment containing either chlorhexidine gluconate or placebo.
Main Outcome Measures Incidence of nosocomial infection, in addition to the rate of Staphylococcus aureus nasal carriage and duration of hospital stay.
Results 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).
Conclusion Decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery.
Trial Registration clinicaltrials.gov Identifier: NCT00272675
Author Affiliations: Departments of Cardiothoracic Surgery (Drs Segers and de Mol) and Clinical Epidemiology, Biostatistics, and Bioinformatics and Surgery (Dr Ubbink), Academic Medical Center, University of Amsterdam; and Departments of Cardiothoracic Surgery (Dr Speekenbrink) and Medical Microbiology (Dr van Ogtrop), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
Chlorhexidine Gluconate for Prevention of Nosocomial Infection in Cardiac Surgery
JAMA. ;297():1059-1060.
FULL TEXT
Chlorhexidine Gluconate for Prevention of Nosocomial Infection in Cardiac Surgery--Reply
, , , , and
JAMA. ;297():1060-1060.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Functional Status Assessment in the Preoperative Evaluation of Older Adults
Malani
JAMA 2009;302:1582-1583.
FULL TEXT
Chlorhexidine, Toothbrushing, and Preventing Ventilator-Associated Pneumonia in Critically Ill Adults
Munro et al.
Am J Crit Care 2009;18:428-437.
ABSTRACT
| FULL TEXT
Update: Methicillin-resistant Staphylococcus aureus screening and decolonization in cardiac surgery.
Tom et al.
Ann. Thorac. Surg. 2009;88:695-702.
ABSTRACT
| FULL TEXT
Postoperative pneumonia after major pulmonary resections: should we try alternative ways to antibiotic change?
Terzi et al.
Ann. Thorac. Surg. 2009;88:707-707.
FULL TEXT
A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia
Pobo et al.
Chest 2009;136:433-439.
ABSTRACT
| FULL TEXT
Not-so-Trivial Pursuit: Mechanical Ventilation Risk Reduction
Grap
Am J Crit Care 2009;18:299-309.
ABSTRACT
| FULL TEXT
Oropharyngeal Cleansing With 0.2% Chlorhexidine for Prevention of Nosocomial Pneumonia in Critically Ill Patients: An Open-Label Randomized Trial With 0.01% Potassium Permanganate as Control
Panchabhai et al.
Chest 2009;135:1150-1156.
ABSTRACT
| FULL TEXT
Decontamination of the Digestive Tract and Oropharynx in ICU Patients
de Smet et al.
NEJM 2009;360:20-31.
ABSTRACT
| FULL TEXT
Measurement of Foot Traffic in the Operating Room: Implications for Infection Control
Lynch et al.
American Journal of Medical Quality 2009;24:45-52.
ABSTRACT
Preventing Ventilator-Associated Pneumonia: Could Silver-Coated Endotracheal Tubes Be the Answer?
Chastre
JAMA 2008;300:842-844.
FULL TEXT
Using data effectively to prevent and control infection
Curran and Wilson
British Journal of Infection Control 2008;9:26-33.
ABSTRACT
Cardiac Surgery in Select Nonagenarians: Should We or Shouldn't We?
Ullery et al.
Ann. Thorac. Surg. 2008;85:854-860.
ABSTRACT
| FULL TEXT
Decontamination of the nasopharynx and oropharynx with chlorhexidine reduced nosocomial infections in cardiac surgery
Maiocco and Brosnahan
Evid. Based Nurs. 2007;10:115-115.
FULL TEXT
Preventing ventilator associated pneumonia
Brun-Buisson
BMJ 2007;334:861-862.
FULL TEXT
Update in Critical Care 2006
Milbrandt et al.
Am. J. Respir. Crit. Care Med. 2007;175:638-648.
FULL TEXT
Chlorhexidine Gluconate for Prevention of Nosocomial Infection in Cardiac Surgery
Scheckler
JAMA 2007;297:1059-1060.
FULL TEXT
Nosocomial Infection in Cardiac Surgery Patients
JWatch General 2006;2006:3-3.
FULL TEXT
A New Approach to Preventing Postoperative Infections
JWatch Infect. Diseases 2006;2006:3-3.
FULL TEXT
Chlorhexidine mouthwash and nasal gel helps prevent infections after cardiac surgery
BMJ 2006;333:1163-1163.
FULL TEXT
|
