A systematic review and meta-analysis of perioperative oral decontamination in patients undergoing major elective surgery

Abstract

BackgroundOral antiseptics reduce nosocomial infections and ventilator-associated pneumonia in critically ill medical and surgical patients intubated for prolonged periods. However, the role of oral antiseptics given before and after planned surgery is not clear. The aim of this systematic review and meta-analysis is to determine the effect of oral antiseptics (chlorhexidine or povidone–iodine) when administered before and after major elective surgery.MethodsSearches were conducted of the MEDLINE, EMBASE and Cochrane databases. The analysis was performed using the random-effects method and the risk ratio (RR) with 95 % confidence interval (CI).ResultsOf 1114 unique identified articles, perioperative chlorhexidine was administered to patients undergoing elective surgery in four studies. This identified 2265 patients undergoing elective cardiac surgery, of whom 1093 (48.3 %) received perioperative chlorhexidine. Postoperative pneumonia and nosocomial infections were observed in 5.3 and 20.2 % who received chlorhexidine compared to 10.4 and 31.3 % who received a control preparation, respectively. Oral perioperative chlorhexidine significantly reduced the risk of postoperative pneumonia (RR = 0.52; 95 % CI 0.39–0.71; p < 0.01) and overall nosocomial infections (RR = 0.65; 95 % CI 0.52–0.81; p < 0.01), with no effect on in-hospital mortality (RR = 1.01; 95 % CI 0.49–2.09; p = 0.98).ConclusionsPerioperative oral chlorhexidine significantly decreases the incidence of nosocomial infection and postoperative pneumonia in patients undergoing elective cardiac surgery. There are no randomised controlled studies of this simple and cheap intervention in patients undergoing elective non-cardiac surgery.Trial RegistrationThis systematic review was registered with the International prospective register of systematic reviews (PROSPERO). The registration number is CRD42015016063.

Preoperative oral care and effect on postoperative complications after major cancer surgery

“…The results may not be generalizable to other countries because the study included only Japanese patients. In addition, chlorhexidine rinses at concentrations of more than 0·005 per cent have been prohibited in Japan because of allergic reactions, but rinses at chlorhexidine concentrations of 0·12–0·2 per cent have been reported to prevent ventilator‐associated pneumonia. It is possible that surgeons who allocated patients to receive preoperative oral care were more likely to diagnose postoperative pneumonia or were more likely to instigate care to prevent postoperative pneumonia.…”

Porphyromonas Gingivalis Load is Balanced by 0.20% Chlorhexidine Gel. A Randomized, Double-Blind, Controlled, Microbiological and Immunohistochemical Human Study

“…It is well known that, to preserve crestal bone loss and guarantee a clinical healthy state around dental implants, it is essential to ensure the decontamination of the implant-healing abutment interface and to use antiseptics during the surgical and prosthetic phases for reducing the degree of contamination [25,46]. Several studies investigated implant materials, surfaces, roughness, healing caps and abutments [40,[47][48][49], but, to the best authors knowledge, this is the first clinical study that investigates, by means of microbiological and immunohistochemical analysis, the P. gingivalis colonization and the inflammatory infiltrate using CHX gel from first to second surgical stage and in prosthetic stage.…”

“…Chlorhexidine is mostly used in chemical plaque control and is effective in decreasing plaque accumulation for its bacteriostatic and bactericidal activities against both Gram-positive and Gram-negative bacteria. Many authors described the use of CHX as a support treatment for peri-implantitis [46,[50][51][52] although, in some cases, its effect seems questionable. In particular, Carcuac et al [53] studied the role of systemic and local medications in the treatment of peri-implantitis concluding that the use of CHX did not improve the outcomes.…”

What are the optimum components in a care bundle aimed at reducing post-operative pulmonary complications in high-risk patients?

“…Several components in this proposed CB have been the subject of detailed studies whilst others such as high-flow nasal oxygen and continuous positive airway pressure are under evaluation (Futier et al 2013b ). Conversely, some interventions that were considered but not selected for the POPC-CB have good evidence of clinical efficacy such as perioperative oral decontamination (Spreadborough et al 2016 ).…”