Preoperative Decolonization Reduces Surgical-Site Infection of Heart Surgery Patients

Objectives: Surgical site infections (SSI) are a rare complication after cardiac surgery. Affected patients suffer from it, have a prolonged hospital stay, and need an expensive therapy. There is ample evidence that preoperative colonization with pathogenic germs is a risk factor for the development of SSI. We investigated the effect of a preoperative reduction of these germs by using a long remanent antiseptic skin solution and nose gel.

Methods: In a retrospective study, we investigated the incidence of SSI after median sternotomy in patients who underwent CABG. We compared two groups. The treatment group (N = 790) received a set with antiseptic skin solution, nose gel accompanied by an instruction and performed preoperative decolonization with octenidine nose gel and octenidine washing solution for at least 3 days at home. The control group (N = 669) only received our standardized preoperative skin disinfection with octeniderm at the time of surgery. Severity of SSI was stratified (FDA criteria) into A1 superficial, A2 sternal bone affected, A3 mediastinitis.

Results: There were no significant differences in the demographic data of both groups. The decolonized treatment group showed a significant lower incidence of all SSI than the control group (0.76 vs. 2.54%, p = 0.012). Especially the prevalence of cases with sternal bone infection (A2 and A3) differed between treatment group 0.12% (1/790) and control group 0.75% (5/669).

Conclusion: Our data support that preoperative decolonization is an easy, highly effective, and low-cost procedure helpful in reducing SSI after cardiac surgery. Yet its implementation is limited by the fact that a growing percentage of patients arrive directly from other hospitals or as an emergency operation, thus limiting the available time for sufficient preoperative treatment.