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DOI: 10.1055/s-0032-1332484
Sternal wound infections avoided: ChloraPrep® Skin Antiseptic passed further clinical tests
Objective: Recolonization by skin flora during cardiac surgeries determines sternal wound infections (SWI). Our preliminary data indicated a five-fold decrease of SWI by the chlorhexidin-based ChloraPrep® Antiseptic compared to alcohol disinfectants. We now tested for SWI and bacterial recolonization in a prospective study of this new antiseptic.
Methods: In July 2011 and from November 2011 to April 2012, we prospectively enrolled all 477 patients undergoing on-pump cardiac surgeries at our institution. Skin swabs were collected after skin prep, before incision (baseline) as well as before skin closure. SWI were evaluated as deep (A2) or affecting other organs (A3). Institutional standards and personnel, as well as patient profiles were unchanged throughout the study.
Results: During periods of alcohol disinfectants (18 months prior to ChloraPrep® and August-October 2011), SWI-A2 and SWI-A3 developed in 59 (2.9%) and 38 (1.8%) of 2069 patients, respectively, translating to 4.9 ± 2.2% SWI/month. When ChloraPrep® was utilized, however, SWI-A2 and SWI-A3 dropped to a mere 4 of 477 (0.8%) and 2 of 477 (0.4%) patients, respectively. Overall infection rates were minimized down to 1.3 ± 1.0% SWI/month (P < 0.01). Baseline bacterial colonization immediately after alcohol-prep and ChloraPrep® antiseptic was negative in 96% and 98%, respectively. Upon skin closure, only 22 of 98 ChloraPrep®-treated patients had intraoperative recolonization. This was in sharp contrast to alcohol prep, in which bacterial recolonization was tripled during surgery (65 of 96 patients, P < 0.05). Noteworthy, SWI predominantly developed in patients with recolonization, wheras only few infections occured in patients without intraoperative recolonization.
Conclusion: SWI are avoided with ChloraPrep® Antiseptic due to its remanent antibacterial effect. ChloraPrep® sets our standard of care if these results are sustained beyond conclusion of this prospective 6-month trial.