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DOI: 10.1055/s-0031-1297466
ChloraPrep® skin antiseptic to reduce sternal wound infections- first clinical results
Objectives: Deep sternal wound infections (SWI) after cardiac procedures are best treated by avoidance. Skin preparation with alcohol-based disinfectants is commonly employed, yet re-colonization with pathogenic bacteria inevitably occurs within hours. The new chlorhexidin based ChloraPrep® Skin Antiseptic acts on skin-dwelling bacteria for 48 hours, and we tested if this preparation allows for a reduction of SWI.
Methods: In July of 2011, we used the ChloraPrep® antiseptic on all 93 patients undergoing cardiac surgery with cardiopulmonary bypass. On the remaining 1,763 patients, operated on pump between January 2010 and June 2011, standard alcohol skin disinfection was used. SWI was evaluated per CDC definition as superficial (A1), deep (A2), or affecting other organs/cavities (A3).
Results: SWI developed at a rate between 4.7% (2010) to 5.0% (first half of 2011) in patients with standard alcohol disinfection, including A3 mediastinitis in 2% (Figure). In contrast, the rate of SWI dropped to a mere 1.1% (1 patient with A2 SWI, no mediastinitis) during the month with the ChloraPrep® antiseptic (Figure). Of note, no other measure to prevent SWI was taken except for the new antiseptic, and the study group was representative of our general patient population as to baseline characteristics and cardiac procedures. Costs of the ChloraPrep® disinfection were higher than the standard antiseptic formulations (e.g., 12.38 € vs. 2.20 € per valve operation) with an estimated annual increase of 18,000 € at our institution. However, this cost increase is likely overcompensated by the reduced SWI related costs.
Conclusion: While we cannot rule out random clustering, the reduction of SWI with usage of ChloraPrep® Skin Antiseptic is impressive. By avoiding long-term hospitalizations due to SWI, morbidity and health care costs are reduced. These results warrant further evaluation, and we have started a 6-months trial comparing the new skin prep with the current standard of care.
Fig.1: SWI