Chest
Volume 109, Issue 6, June 1996, Pages 1556-1561
Journal home page for Chest

Clinical Investigations: Infection
Chlorhexidine Gluconate 0.12% Oral Rinse Reduces the Incidence of Total Nosocomial Respiratory Infection and Nonprophylactic Systemic Antibiotic Use in Patients Undergoing Heart Surgery

https://doi.org/10.1378/chest.109.6.1556Get rights and content

Study objective

The purpose of this study was to test the effectiveness of oropharyngeal decontamination on nosocomial infections in a comparatively homogeneous population of patients undergoing heart surgery.

Design

This was a prospective, randomized, double-blind, placebo-controlled clinical trial. Experimental and control groups were selected for similar infection risk parameters.

Setting

Cardiovascular ICU of a tertiary care hospital.

Patients

Three hundred fifty-three consecutive patients undergoing coronary artery bypass grafting, valve, or other open heart surgical procedures were randomized to an experimental (n=173) or control (n=180) group. Heart and lung transplantations were excluded.

Interventions

The experimental drug chosen was 0.12% chlorhexidine gluconate (CHX) oral rinse.

Measurements and results

The overall nosocomial infection rate was decreased in the CHX-treated patients by 65% (24/180 vs 8/173; p<0.01). We also noted a 69% reduction in the incidence of total respiratory tract infections in the CHX-treated group (17/180 vs 5/173; p<0.05). Gram-negative organisms were involved in significantly less (p<0.05) of the nosocomial infections and total respiratory tract infections by 59% and 67%, respectively. No change in bacterial antibiotic resistance patterns in either group was observed. The use of nonprophylactic IV antibiotics was lowered by 43% (42/180 vs 23/173; p<0.05). A reduction in mortality in the CHX-treated group was also noted (1.16% vs 5.56%).

Conclusions

Inexpensive and easily applied oropharyngeal decontamination with CHX oral rinse reduces the total nosocomial respiratory infection rate and the use of nonprophylactic systemic antibiotics in patients undergoing heart surgery. This results in significant cost savings for those patients who avoid additional antibiotic treatment.

Section snippets

MATERIALS AND METHODS

The study protocol was prospective, randomized, double-blind, placebo-controlled, and was approved by the Institutional Review Board of Lutheran Hospital of Indiana. Patients were entered into the study only after written informed consent was obtained. Concurrent participation in another research protocol was not permitted. Consecutive eligible patients who underwent coronary artery bypass grafting (CABG), valve surgery, septal surgery, cardiac tumor excision, or combined CABG valve surgery

RESULTS

Of the 353 patients who were included in the analysis, 173 patients were randomized to the CHX group and 180 to the placebo group. Table 1 illustrates that the two groups were not statistically different with regard to age, sex, type of surgery, preoperative pulmonary risk factors, preoperative WBC count, cardiopulmonary bypass time, number of bypass grafts performed, or first postoperative day albumin levels.

There was no significant difference in the number of emergency or reoperative

DISCUSSION

Our data indicate that our nosocomial infection rate is reduced by CHX treatment with individual reduction in our respiratory infection rate by 69%, but not in wound, blood, and urinary nosocomial infection rates. Furthermore, our study documents a 43% decrease in the need for nonprophylactic systemic IV antibiotics in treated patients. This finding is in accord with the conclusion of Pugin et al5 who recognized a decreased need for systemic antibiotics in mechanically ventilated ICU patients

CONCLUSION

In summary, this report shows that CHX decreases the total respiratory infection rate and the use of nonprophylactic IVs antibiotics in patients undergoing heart surgery. This results in significant cost savings for those patients who avoid treatment with additional antibiotics, and may impact favorably on mortality.

REFERENCES (33)

  • Rodriguez-RoldanJM et al.

    Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste

    Crit Care Med

    (1990)
  • StoutenbeekCP et al.

    The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients

    Intensive Care Med

    (1984)
  • UlrichC et al.

    Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study

    Intensive Care Med

    (1989)
  • UnertlK et al.

    Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis

    Intensive Care Med

    (1987)
  • GastinneH et al.

    A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics

    N Engl J Med

    (1992)
  • Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract

    BMJ

    (1993)
  • Cited by (394)

    • Techniques in Enteral Access

      2019, Clinical Gastrointestinal Endoscopy
    View all citing articles on Scopus

    This study was supported by a grant from the August Tomusk Foundation in Fort Wayne, Indiana.

    Presented at the 22nd World Congress of the International Society of Cardiovascular Surgeons, Kyoto, Japan; September, 1995.

    revision accepted November 5.

    View full text