title: Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Oropharyngeal rinse and nasal ointment containing either chlorhexidine gluconate or placebo.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00272675.
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. p.segers@amc.uva.nl
authors.forename: Patrique
authors.initials: P
authors.lastname: Segers
authors.forename: Ron G H
authors.initials: RG
authors.lastname: Speekenbrink
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: Marc L
authors.initials: ML
authors.lastname: van Ogtrop
authors.forename: Bas A
authors.initials: BA
authors.lastname: de Mol
mesh_terms: D000281:Administration, Intranasal; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D002353:Carrier State; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005782:Gels; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes; D009305:Nasopharynx / Q000382:microbiology*; D009960:Oropharynx / Q000382:microbiology*; D019990:Perioperative Care; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000891:Anti-Infective Agents, Local; D005782:Gels; D009067:Mouthwashes; C010882:chlorhexidine gluconate; D002710:Chlorhexidine