Reducing Surgical Complications: SSI and HAP

Surgical site infections (SSIs) add 7 to 11 days to a patient’s length of stay1 and increase costs by an average of $25,546.2 Patients who develop an SSI are also “twice as likely to die.”3

Patient preoperative skin preparation addresses a known risk factor for SSIs—microorganisms on the skin.1 This education section will help you bolster your SSI prevention efforts by implementing a rinse-free 2% chlorhexidine gluconate (CHG) formulation with a disposable applicator cloth.

The oral cavity is a proven source of bacteria, commonly associated with hospital-acquired pneumonias (HAPs).4 Bacteria, including dental plaque, can colonize in the oropharyngeal area, and these pathogens can be aspirated into the lungs, causing infection.5

For patients who will be intubated, administering comprehensive oral care before surgery can help minimize bacteria than can cause HAP. Click here to learn why oral care is an important element of the preoperative and perioperative care of short-term ventilated patients.

REFERENCES: 1. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6): 605–627. 2. Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control. 2005;33(9):501-509 3. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725-730 4. Schleder B, Stott K, Lloyd R. The effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonia. J Advocate Health. 2002;4(1):27-30 5. Scannapieco F. Role of oral bacteria in respiratory infection. J Periodontol. 1999;70(7):793-802.

Effect of a Preoperative Decontamination Protocol on Surgical Site Infections in Patients Undergoing Elective Orthopedic Surgery With Hardware Implantation
Serge P. Bebko MD, David M. Green MD, Samir S. Awad MD, MPH
JAMA Surgery, May 2015
View abstract

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?
Kapadia BH, Jauregui JJ, Murray DP, Mont MA
Clinical Orthopaedics and Related Research, 2016
View abstract

Chlorhexidine reduces infections in knee arthroplasty
Johnson A, Kapadia B, Dailey J, Moline C, Mont M
Journal of Knee Surgery, June 2013
View abstract

Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission?
Edmiston CE, Krepel CJ, Seabrook GR, Lewis BD, Brown KR, Towne JB
J Am Coll Surg. 2008 Aug;207(2):233-9
View abstract

Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection
Engemann JJ, Carmeli Y, Cosgrove SE, Fowler VG, Bronstein MZ, Trivette SL, Briggs JP, Sexton DJ, Kaye KS
Clinical Infectious Diseases. Mar 2003;36(5):592-8.
View full text

Perioperative Antisepsis Protocol Initiative
Thompson B
APIC 2014
Download poster (PDF)
Revisiting Process Improvement for Total Joint Arthroplasty Surgical Site Infections
Waibel M
Presented at the Conference of Association for Professionals in Infection Control and Epidemiology, Ft. Lauderdale, FL, June 8-10, 2013
Download poster (PDF)
An Orthopaedic Surgical Decolonization Protocol
Story A
University of Missouri Healthcare Preliminary Results Hip and Knee
Download poster (PDF)
The Effect of Universal Intranasal Povidone Iodine Antisepsis on Total Joint Replacement Surgical Site Infections
Brown L
Poster presented at APIC 2014
Download poster (PDF)
A Novel Immediate Pre-Operative Decolonization Strategy Reduces Surgical Site Infections
Bryce E
Poster presented at the International Consortium for Prevention & Infection Control (ICPIC) Conference 2013
Download poster (PDF)
A Multifaceted Approach Reduces Surgical Site Infection Rates, Incidents, and Associated Costs for Abdominal Hysterectomy and Caesarean Section Patients
Mauzey S
Poster presented at the Association for Professionals in Infection Control & Epidemiology (APIC), San Antonio, TX, June 2012
Download poster (PDF)
Preventing Orthopedic Total Joint Replacement Surgical Site Infections through a Comprehensive Best Practice Bundle/Checklist
Hogenmiller J
Presented at the APIC National Conference in Baltimore, MD, June 2011
Download poster (PDF)
Drop a Bundle and Save: Reducing Surgical Site Infections Across Surgical Populations
Farber M
(NTI) National Teaching Institute & Critical Care Exposition: May 15-20, 2010
Download poster (PDF)
Download handout (PDF)
Chlorhexidine gluconate preoperative skin preparation initiated a 100% reduction of incisional Cesarean section infections while other risk factors were evaluated and corrected
Rauk P
Poster presented at 2008 APIC Annual Conference: June 15-19, 2008
Download poster (PDF)
Download handout (PDF)

A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals
SHEA 2014
View full text

Guide to the Elimination of Orthopedic Surgical Site Infections
APIC 2010
Download complete guideline (PDF)

Guideline for the Prevention of Surgical Site Infection, 2017
Download complete guideline (PDF)

Nonventilator hospital-acquired pneumonia in the surgical population
Heather Hohenberger
AORN Journal, January 2017
View abstract