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Preoperative oral hygiene recommendation before open-heart surgery: patients’ adherence and reduction of infections: a quality improvement study
  1. Preben Ulrich Pedersen1,
  2. Anita Tracey2,
  3. Jesper Eske Sindby2,
  4. Merete Bjerrum3
  1. 1 Aalborg University, Department of Clinical Medicine, Centre of Clinical Guidelines and Clinical Research Unit, Aalbirg University Hospital, Aalborg University, Aalborg, Denmark
  2. 2 Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
  3. 3 Section of Nursing Research, Aarhus Universitet, Aarhus, Denmark
  1. Correspondence to Professor Preben Ulrich Pedersen, Aalborg University; pup{at}


Aim To implement recommendations for oral hygiene before elective open-heart surgery in a thoracic surgery ward and to evaluate whether the number of patients who needed to be treated with antibiotics postoperatively was reduced.

Background Healthcare systems are challenged to implement initiatives that reduce the development of nosocomial infections, to offer patients a safe and cost-efficient treatment and to reduce the use of antibiotics. Previous interventions have focused on staff behaviour in reducing postoperative infections. In this study, patients were recommended to carry out oral hygiene as recommended in a clinical guideline.

Methods A quasiexperimental design with a control and an intervention group was used. Information on adherence to the recommendation was collected at admission. All medical information and prescriptions of antibiotics were obtained from patients’ medical records. Data were reported as intention to treat.

Results Altogether 972 patients (506 controls and 466 interventions) were included in the study. Of the intervention patients, 405 (86.9%, 95% CI 83.3 to 89.8) reported that they had adhered to the oral hygiene recommendation. 64 (12.6%) control patients and 36 (7.7%) in the intervention group (p=0.015) were treated with antibiotics postoperatively.

Conclusions It was feasible to involve patients in a programme for oral hygiene and thereby reduce the number of patients needing antibiotics after open-heart surgery and this might contribute to reducing costs.

  • healthcare quality improvement
  • antibiotic management
  • evidence-based medicine
  • patient safety
  • nosocomial infections

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  • Contributors PUP: planning, conducting and reporting the project. AT: planning and conducting the project. JES: planning and reporting the project. MB: reporting the project.

  • Funding The study has been supported by a grant from the Danish Ministry of Health (file number jnr 1406151) and by Region Nord in Denmark.

  • Competing interests None declared.

  • Ethics approval The study was approved by the local ethical committee and by the Danish Data Protection Agency under file numbers 2008-58-0028/2012-58-0015 and 2015-44.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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