Level 1: Likely reliable evidence

For prevention of nosocomial infection after cardiothoracic surgery, the efficacy of decontamination of the nasopharynx and oropharynx was evaluated in a randomized trial of 991 adults having sternotomy (JAMA. 2006;296:2460-246). Patients were randomized to chlorhexidine gluconate 0.12% vs. placebo as oral rinse (10 mL for 30 seconds) plus nasal gel four times daily until the nasogastric tube was removed, usually the day after surgery.

All patients had two showers using chlorhexidine gluconate soap on the day before surgery, skin disinfection with chlorhexidine 0.5%/alcohol 70% solution, and cefuroxime (Zinacef) IV for antibiotic prophylaxis. Fifteen (3%) chlorhexidine gluconate patients and 22 (4.5%) placebo patients were excluded from analysis due to discontinuing treatment or receiving an alternative preoperative antibiotic regimen. Outcomes that favored chlorhexidine gluconate included rates of nosocomial infections (19.8% vs. 26.2% had 116 vs. 164 infections, P=.002, NNT 16), lower respiratory tract infection (9.3% vs. 15.8%, P=.002, NNT 16), bacteremia (1.9% vs. 3.6%, P=.001, NNT 59), deep surgical-site infection defined as wound defect with infection beneath subcutaneous layers (1.9% vs. 5.1%, P=.002, NNT 32), and duration of total hospital stay (9.5 vs. 10.3 days, P=.04).

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Nonsignificant findings included rates of UTI (2.9% vs. 4.8%, P=.09), sternal-site infection (5.3% vs. 6.4%), duration of intensive care stay (1.2 vs. 1.3 days), and mortality (1.7% vs. 1.3%).