Reducing the Risk of Surgical Site Infections: What is the Evidence?

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At the 2011 Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago, Matthew Saltzman, MD, assistant professor at Northwestern University Feinberg School of Medicine, shared a presentation on surgical site infections and an overview of studies on infection prevention.

There is a wide range of risk factors for surgical site infections, some of which are under healthcare providers' control. These include methods for hair removal and skin preparation, OR ventilation and equipment sterilization. Other modifiable risks include glucose control, preoperative CHG showers, hand hygiene and antimicrobial prophylaxis.

 

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Several studies suggest certain methods help reduce the risk of surgical site infections. One study showed that clippers are a better method for hair removal than normal razors, based on evidence razors could create tiny cuts that allow bacteria to enter the body, Dr. Saltzman said.

Another highly contentious topic is the ideal antimicrobial, which should have a broad spectrum, rapid activity and persistence, among other features. A close analysis of available antimicrobials shows any antimicrobial singularly only fulfills a few of these ideal characteristics. The combination of chlorhexidine gluconate with alcohol seems to accomplish most of these.

One high-quality study, published last year in the New England Journal of Medicine, concluded chlorhexidine-alcohol was more effective than povidone-iodine in reducing the risk of infections.  The same study showed that even though the chlorhexidine-alcohol product used in the research was significantly more expensive than the povidone-iodine product, the chlorhexidine-alcohol product still generated more cost-savings. This is due to lower costs associated with a lower number of surgical site infections when using chlorhexidine-alcohol.

Related Articles on Surgical Site Infections:
Patient Safety Tool: 'BEAGLES' Poster for Surgical Site Infection Prevention
Patient Safety Tool: 'CATS' Poster for Surgical Site Infection Intervention
NQF Releases Updated List of 29 Serious Reportable Events

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