title: Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery.
abstract: OBJECTIVE
  To evaluate the effect of pre-operative octenidine (OCT) decolonization on surgical site infection (SSI) rates.
  
  
  METHODS
  Before-and-after cohort study.
  
  
  METHODS
  Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control group (1stJanuary to 31stDecember 2013), N=475; intervention group (1stJanuary to 31stDecember 2014), N=428.
  
  
  METHODS
  The intervention consisted of nasal application of OCT ointment three times daily, beginning on the day before surgery, and showering the night before and on the day of surgery with OCT soap.
  
  
  RESULTS
  A median sternotomy was performed in 805 (89.1%) patients and a minimally invasive direct coronary artery bypass procedure was performed in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention groups (15.4% vs 13.3%, P=0.39). The rate of harvest site SSIs was significantly lower in patients in the intervention group (2.5% vs 0.5%, P=0.01). Patients who had undergone a median sternotomy in the intervention group had a significantly lower rate of organ/space sternal SSIs (1.9% vs 0.3%, P=0.04). However, there was a trend towards an increased rate of deep incisional sternal SSIs (1.2% vs 2.9%, P=0.08). Multi-variate analysis did not identify a significant protective effect of the intervention (odds ratio 0.79, 95% confidence interval 0.53-1.15, P=0.27).
  
  
  CONCLUSIONS
  Pre-operative decolonization with OCT did not reduce overall SSI rates in patients undergoing an elective isolated CABG procedure, but significantly decreased harvest site and organ/space sternal SSIs. Randomized controlled trials, including controlled patient adherence to the intervention, are required to confirm these observations and to determine the clinical utility of OCT in pre-operative decolonization.
authors.affiliation: Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Reiser
authors.affiliation: Integrated Research and Treatment Centre, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Scherag
authors.affiliation: Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Forstner
authors.affiliation: Centre for Clinical Studies Jena, Jena University Hospital, Jena, Germany.
authors.forename: F M
authors.initials: FM
authors.lastname: Brunkhorst
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Harbarth
authors.affiliation: Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Doenst
authors.affiliation: Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
authors.forename: M W
authors.initials: MW
authors.lastname: Pletz
authors.affiliation: Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Integrated Research and Treatment Centre, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany. Electronic address: stefan.hagel@med.uni-jena.de.
authors.forename: S
authors.initials: S
authors.lastname: Hagel
mesh_terms: D000281:Administration, Intranasal; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007097:Imines; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D009824:Ointments / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods*; D011725:Pyridines / Q000008:administration & dosage*; D012915:Soaps; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D013903:Thoracic Surgery
chemical_list: D000891:Anti-Infective Agents, Local; D007097:Imines; D009824:Ointments; D011725:Pyridines; D012915:Soaps; C034213:octenidine
keywords: Body wash; Cardiac surgery; Nasal; Octenidine; Surgical site infection