SSIs: A Problem With No Quick Fix
This column will appear in the upcoming May print issue of Surgical Products.
It is generally accepted that the best approach for preventing SSIs uses a bundle of evidence-based practices. The Surgical Care Improvement Project (SCIP) is a well-known prevention bundle that focuses on modifiable risk factors. SCIP measures are required for accreditation by The Joint Commission and include appropriate antibiotic administered within one hour of surgical incision, controlled blood sugar, appropriate hair removal, timely removal of urinary catheters, and perioperative temperature management.
Hand hygiene is the only infection prevention intervention that persists across the entire continuum of perioperative care. Compliance with hand hygiene before and after patient contact is necessary for safe patient care during the preoperative, operative, and post-operative time periods. Strict attention to hand hygiene and gloving during wound care and dressing changes during post-operative care is essential. Hand hygiene is a fundamental component of SSI prevention bundles.
Less progress has been made in preventing surgical site infections than other HAIs. With current evidence-based interventions, 55 percent of SSIs are considered preventable. (4) Research and quality improvement efforts are clearly needed to determine which process measures and product innovations should be added to our existing infection prevention bundles.
Much progress has already been made in products used for both routine hand hygiene and surgical hand antisepsis. Alcohol-based handrubs are quick, easy, more effective, and less drying than soap and water for routine hand hygiene. Convenient placement of dispensers and personal carriage of individual bottles of handrub are helpful in the fast-paced environment of perioperative care. New alcohol-based handrub formulas that are effective in practical in-use volumes add to the value of these products.
The introduction of alcohol-based preparations has also made significant improvements in surgical hand antisepsis. Brushes and water-assisted scrubs are no longer needed and as far back as 2009, an independent Cochrane Review concluded that alcohol rubs are at least as, if not more, effective than aqueous scrubs. (5) More recently, alcohol-based surgical scrub preparations without the addition of chlorhexidine gluconate (CHG) demonstrated the ability to meet Federal Drug Administration (FDA) efficacy criteria for immediate and persistent bacterial kill. (6) This is good news for healthcare professionals who have found CHG containing products to be drying and a cause of skin irritation.
As we wait for randomized, controlled clinical trials of new interventions and products, it’s imperative that we implement all the components of evidence-based bundles that have been proven to prevent surgical-site infections.
1. Zimlichman E et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173(22):2039-46.
3. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect 2012;13(4):134-7.
4. Umscheid CA et al. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32(2):101-14.
5. Tanner J et al. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database of Systematic Reviews 2008, Issue 1.
6. Edmonds SL et al. Comparison of the in vivo efficacy of alcohol-based pre-surgical hand rubs: chlorhexidine gluconate is not necessary to meet FDA efficacy requirements. 2013 APIC 40th Annual Educational Conference and International Meeting. Fort Lauderdale, FL.
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