Reduction of Sternal Wound Infections with Combined Chlorhexidine–Isopropyl Alcohol Skin Disinfection in Patients Undergoing Bilateral Mammarian Artery Bypass Surgery

Objective: Patients undergoing coronary artery bypass grafting (CABG) using bilateral mammarian arteries (BIMA) are at increased risk for superficial and deep sternal wound infections (SSWI / DSWI) with an excessively varying reported incidence between 1- 44%,depending on comorbidities and BIMA harvesting technique. We compared our standard preoperative skin disinfection using isopropyl alcohol (IPA) to combined chlorhexidine-IPA (CHG-IPA), (ChloraPrep®) skin antiseptic on the incidence of sternal wound infections after BIMA CABG.

Methods: We prospectively collected data of 579 consecutive patients undergoing CABG using BITA. Group A (n = 287) had skin disinfection using IPA, in Group B (n = 292) CHG-IPA was used. The occurrence of SSWI and DSWI during 30 day follow up was evaluated.

Results: The overall incidence of sternal wound infections was 20/ 287(7%) in Group A and 13/292(4.5%) in Group B. Patient demographics and incidence of SSWI and DSWI are shown in [Table 1].

Table 1

	Group A	Group B
Age (mean)	68	67
Male (n/%)	229/80	235/80
Body mass index (mean)	27	27
Diabetes mellitus (n/%)	87/30	102/35
Peripheral vascular disease (n/%)	55/19	54/18
Sternal wound infections overall (n/%)	20/7	13/4.5
SSWI (n/%)	8/2.8	7/2.4
DSWI (n/%)	12/4.2	6/2.1

Conclusion: Preoperative skin disinfection with combined chlorhexidine-IPA (ChloraPrep) is superior to isopropyl alcohol (IPA) for preventing sternal wound infections after CABG using BIMA. With increasing public attention to quality reports and hospital rankings, infection rates will have a strong impact in the near future on the decision making process, specifically in CABG patients, whether to use BIMA or not.

No conflict of interest has been declared by the author(s).