Chlorhexidine mouthwash and nasal gel helps prevent infections after cardiac surgery

Researchers from Holland have found a safe, effective, and cheap way of protecting patients from nosocomial infections after cardiac surgery. In their randomised controlled trial chlorhexidine mouthwash and nasal gel significantly reduced the incidence of postoperative infections (19.8% v 26.2%, absolute risk reduction 6.4% (95% CI 1.1% to 11.7%)). The researchers estimate that the disinfectant prevented one extra infection for every 16 patients treated. It also reduced nasal carriage of Staphylococcus aureus by over 50%.

The treatment, which contained 0.12% chlorhexidine gluconate, began the day before surgery and continued four times daily until the patient's nasogastric tube was removed. It seemed particularly effective against lower respiratory tract infections (9.3% v 15.8%, P=0.002, number needed to treat 15) and deep infections at the surgical site (1.9% v 5.1%, P=0.002), both of which can be devastating after cardiac surgery.

Patients who used the disinfectant went home from hospital just under a day earlier on average than patients given identical placebo mouthwash and gel. But treatment had no effect on in-hospital mortality (1.5%). The only side effect was a temporary discolouration of the teeth, reported by one patient.

This trial included 954 unselected adults scheduled for a variety of cardiac operations. The authors say their findings reflect typical cardiac surgery practice and should be widely generalisable to other hospitals.