葡萄糖酸洗必泰皮肤清洁报告

“Preoperative bathing has not yet been given the attention it deserves.”
— Phenelle Segal, RN, CIC, founder and president of Infection Control Consulting Services
P
reoperative skin cleansing is a common evidence-based practice that may reduce the risk of patients acquiring a surgical site infection (SSI) -- yet there are divergent ways the practice being implemented. Lack of standard guidelines creates confusion on the part of healthcare workers and patients – leading to poor compliance and increased risk of harm. “Preoperative bathing has not yet been given the attention it deserves,” says Phenelle Segal, RN, CIC, founder and president of Infection Control Consulting Services. Several years ago, surgeons began to shy away from preoperative patient skin cleansing – primarily in the inpatient setting – because there was no clear-cut evidence that the practice had a direct impact on preventing SSIs, Segal explains. Over time, the practice has reappeared as more studies show that preoperative skin cleansing can significantly reduce the microbial load on a patient’s skin. Chlorhexidine gluconate (CHG) is the “antiseptic of choice,” Segal says. At first, surgeons mainly required preoperative bathing for procedures like orthopedic, spinal and brain cardiac surgery. The continued threat of infections caused by methicillin-resistant Staphylococcus aureus (MRSA), however, prompted many doctors to require preoperative bathing for even routine surgeries, Segal notes.
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infectioncontroltoday.com
INFECTION CONTROL
T O D A Y
Table of Contents
The Cost of SSIs ......................................................3 CHG-Impregnated Cloths ...........................................5 No Nationwide Guidelines ..........................................6 Facing Challenges ....................................................9 References ............................................................10
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The Cost of SSIs
The World Health Organization (WHO) estimates 780,000 surgical site infections occur annually in the United States – resulting in 3.7 million excess hospital days and costing the U.S. healthInfection Control Today • Skin Cleansing 3 infectioncontroltoday.com
January 2014
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S P E C I A L
R E P O R T
Preoperative Skin Cleansing: Education Needed to Combat Variable Compliance
By Karin Lillis
Infection Control Today • Skin Cleansing
Infection Control Today • Skin Cleansing
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infectioncontroltoday.com
Preoperative Skin Cleansing: Education Needed to Combat Variable Compliance
By Karin Lillis
care system $1.6 billion to $3 billion.1 Surgical site infections account for around 23 percent of all hospital-acquired infections, according to WHO. The Centers for Disease Control and Prevention (CDC), however, says that number was 31 percent of all HAIs.2 “While advances have been Widely publicized made in infection control practices... SSIs remain a substantial cause of guidelines from morbidity, prolonged hospitalization and death,” the CDC document’s authors write. “SSI is associated with a mortality rate of 3 percent, and the Association 2 75 percent of SSI-associated deaths are directly attributable to the SSI.” of periOperative Additionally, a September 2013 study by Harvard researchers suggests Registered Nurses that 1 in 50 patients undergoing surgical procedures will contract an SSI, (AORN) and costing $21,000 per case.3 A patient with an SSI is five times more likely a 1999 report to be readmitted after discharge, twice as likely to spend time in the ICU and twice as likely to die after surgery.4 from the CDC Yet these infections can be prevented. underscore the Widely publicized guidelines from the Association of periOperative role pre operative Registered Nurses (AORN) and a 1999 report from the CDC underscore skin cleansing the role preoperative skin cleansing plays in reducing the risk of SSI. The plays in reducing AORN guidelines state in part, “One randomized clinical trial found two consecutive showers or baths with 4 percent CHG resulted in lower surthe risk of SSI. gical site infection rates than bar soap (i.e., 9 percent vs. 12.8 percent). Showering three times with 4 percent CHG was found to reduce skin flora 20-fold preoperatively and to lower bacterial counts of the incision taken at the end of the procedure.”5 Specifically, research indicates that repeated use of CHG soap can reduce the amount of bacteria on the skin – immediately and for a number of hours after application.6 In one study, volunteers used CHG solution to shower or bathe for five days. The researchers found that the microbial load was progressively and significantly reduced.6 Hospitals that require some sort of preoperative CHG bathing procedure are reporting favorable results. For example, Children’s National Medical Center in Washington, D.C. reported a 54 percent decrease in SSIs after the introduction of three interventions – including CHG preoperative baths.7 At St. Mary’s Regional Medical Center in Russellville, Ark., infection control staff “noticed that most SSIs centered around orthopedic cases.” The hospital introduced a two-step CHG cleansing routine before each orthopedic surgery – a shower or bath the night before surgery, followed by a 2-minute scrub with 2 percent CHG solution. The 2-minute/2-percent routine was repeated during the preoperative period. St. Mary’s reported a 66 percent reduction in SSIs among its orthopedic surgery patients, so the hospital “expanded the program to most surgical cases.”7