Does prophylactic oral decontamination with chlorhexidine reduce
nosocomial pulmonary infections in adults undergoing open-heart
surgery?
Contact: Weiss, Richard, 15.10.2007
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questions/Results
Authors: Richard Weiß*, Daniela Bachner**, Eveline Brandstätter*, Susanna Schaffer*, Barbara
Semlitsch*, Christine Uhl*, University Hospital, Graz*, Geriatric Health Centers, Graz**/October
2007
Nursing question
Does oral decontamination with chlorhexidine 0.12% reduce the rate of nosocomial
pneumonia in adults undergoing heart surgery?
Keywords
Chlorhexidine, heart surgery, nosocomial infection, respiratory infection
Literature databases and Internet addresses
PubMed, Cochrane Library, Cinahl; Embase
Answer
Pre- and postoperative decontamination with chlorhexidine 0.12% significantly reduces
nosocomial pneumonia in adults undergoing heart surgery.
Evidence: Medium
Application
An oropharyngeal rinse was applied with chlorhexidine 0.12%, 10 ml for 30 seconds, once
before surgery and postoperatively thrice daily until discharge from the ICU. For ventilated
and intubated patients, chlorhexidine was applied to the inside of the cheeks, and to the
gums, teeth, tongue and pharynx. Chlorhexidine ointment was also applied to the nostrils
(Segers, Speekenbrink, Ubbink, van Ogtrop, & de Mol, 2006). No effectiveness was shown
with twice-daily oropharyngeal rinse without decontamination of the nostrils (DeRiso,
Ladowski, Dillon, Justice, & Peterson, 1996).
Literature
Selected articles:
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
DeRiso, A. J., 2nd, Ladowski, J. S., Dillon, T. A., Justice, J. W., & Peterson, A. C.
(1996). Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total
nosocomial respiratory infection and nonprophylactic systemic antibiotic use in
patients undergoing heart surgery. Chest, 109(6), 1556-1561.
Segers, P., Speekenbrink, R. G. H., Ubbink, D. T., van Ogtrop, M. L., & de Mol, B.
A. (2006). Prevention of nosocomial infection in cardiac surgery by decontamination
of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized
controlled trial. JAMA: Journal of the American Medical Association, 296(20), 2460-
2466.
Appendix: Evidence grade by grade / Interpretation (pdf)