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Chlorhexidine cuts nosocomial infection

Chlorhexidine cuts nosocomial infection
Amsterdam, the Netherlands - A team of Dutch doctors has come up with a cheap, simple, and effective way to reduce nosocomial infection after cardiac surgery using a commonly available disinfectant, chlorhexidine gluconate .

The procedure should be applicable to all forms of major surgery, the lead investigator, Dr Patrique Segers (Academic Medical Center, University of Amsterdam, the Netherlands), told heartwire. Segers and colleagues report their findings in the November 22, 2006 issue of the Journal of the American Medical Association.

He said the results emphasize that hospital-acquired infections should not be overlooked. "Cardiac surgery is major surgery, but it is done every day. The rate of complications is not high, but there is still a significant rate of infection occurring afterward, and we need to remember that prevention is of the utmost importance."
Chlorhexidine is bactericidal and bacteriostatic for up to 12 hours
Segers and colleagues explain that the rate of nosocomial infection after cardiac surgery is around 20% and that such infections are an important cause of morbidity and mortality, prolonging hospital stay and requiring antibiotic treatment. Although potentially pathogenic microorganisms can be transmitted to patients from the hands of healthcare workers and from contaminated equipment, the primary source of infections is the patient's own flora, they explain.

Currently, some hospitals use topical antibiotics such as mupirocin to try to eradicate organisms such as Staphylococcus aureus—the most important pathogen responsible for surgical site infections. However, not everyone is convinced of the effectiveness of this approach, Segers told heartwire, and there is concern that overuse of such antibiotics will lead to the emergence of resistant strains of the bacteria.

Another approach used in some places involves selective decontamination of the digestive tract of the patient, he added, but this is expensive—it costs approximately €200 per patient—and has shown inconclusive results in trials so far.

His team decided to investigate the use of chlorhexidine gluconate in a prospective, randomized, double-blind, placebo-controlled trial in 954 patients undergoing elective cardiothoracic surgery at one institute in the Netherlands from 2003 to 2005. They note that the disinfectant has a high level of antibiotic activity; it binds electrostatically to surfaces, where it exerts bactericidal and bacteriostatic effects for up to 12 hours. In addition, it is virtually devoid of adverse effects.

A 0.12% chlorhexidine gluconate solution or placebo was used as an oral rinse and a gel for nasal application four times daily, before and after surgery. All patients also received cefuroxime perioperatively as well.
Use of chlorhexidine reduces hospitalization by one day
The incidence of nosocomial infection in the chlorhexidine and placebo groups was 19.8% and 26.2%, respectively (absolute risk reduction [ARR] 6.4%; p=0.002). In particular, lower respiratory-tract infections and deep surgical site infections were less common in the chlorhexidine group (ARR 6.5%; p=0.002 and ARR 3.2%; p=0.002, respectively).

For the prevention of one nosocomial infection, 16 patients need to be treated with chlorhexidine gluconate, which makes it an inexpensive preventive measure, Segers said. The cost of the chlorhexidine treatment is only €6 (US $7.20) per day, which means that the cost to prevent one nosocomial infection is around €192 (US $230).

Total hospital stay was 9.5 days for those treated with chlorhexidine, compared with 10.3 days in the placebo group (p=0.04). In the Netherlands, each extra day in hospital costs around €1000, Segers told heartwire, making the chlorhexidine strategy extremely cost-effective.

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