To the Editor: Dr Segers and colleagues1 presented a randomized controlled trial that studied the prevention of nosocomial infections in patients undergoing cardiac surgery by using chlorhexidine gluconate to decontaminate the nasopharynx and oropharynx. This study was conducted in a community hospital in the Netherlands, and we are concerned that the results may not be generalizable to hospitals in the United States.
Data from more than 300 US hospitals are present in the National Nosocomial Infections Surveillance System (NNIS) program of the Centers for Disease Control and Prevention2 (now part of the National Healthcare Safety Network). They indicate important differences from the population studied in the article by Segers et al. In a study of 7835 US patients undergoing surgery, the average length of stay after coronary artery bypass graft (CABG) surgery was 8.6 days3 ; whereas, in the article by Segers et al, the length of stay was a mean of 9.5 days in the intervention group and 10.3 days in the placebo group. Their study required a stay of more than 1 day to be considered for inclusion in the study; whereas, most patients in the United States may be admitted on the morning of surgery. Of greatest importance is the high rate of deep surgical (mediastinal) wound infections (1.9% in the treatment group and 5.1% in the placebo group) compared with less than 1% in the NNIS database.2
These differences suggest that the use of chlorhexidine gluconate, although effective in Segers et al, may not improve outcomes in the United States.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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