Effect of preoperative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery

• Published in: The Journal of hospital infection 2016
• Main Authors: Reiser, Mira, Scherag, André, Dr. rer. physiol., MS, Forstner, Christina, MD, Brunkhorst, Frank M., MD, Harbarth, Stephan, MD, MS, Doenst, Torsten, MD, Pletz, Mathias W., MD, Hagel, Stefan, MD, MS
• Format: Article
• Language: English
• Subjects: Infectious Disease
• ISSN: 0195-6701
• DOI: 10.1016/j.jhin.2016.11.004

Abstract Objective To evaluate the effect of preoperative octenidine (OCT) decolonization on surgical site infection (SSI) rates. Design Before-and-after cohort study. Patients Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control cohort (Jan 1st through Dec 31st 2013), n=475; intervention cohort (Jan 1st through Dec 31st 2014), n=428. Interventions The intervention consisted of nasal application of OCT ointment 3 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 in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention group (15.4% vs. 13.3%, p=0.39). The rate of harvest site SSI was significantly lower in patients receiving the intervention (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 SSI (1.2% vs. 2.9%, p=0.08). Multivariate analysis did not identify a significant protective effect of the intervention (OR 0.79, 95% CI (0.53-1.15), p=0.27). Conclusions Preoperative 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 however inevitably required to confirm our observation and to definitively determine the clinical utility of OCT in preoperative decolonization.