Reducing Surgical Complications: SSI

Surgical site infections (SSIs) add 7 to 10 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 new 2% chlorhexidine gluconate (CHG) formulation with a disposable applicator cloth.

The oral cavity is a proven source of hospital-acquired pneumonias (HAPs), including ventilator-associated pneumonia (VAP).4,5 Bacteria that cause hospital-acquired respiratory disease colonize the oropharyngeal area, including dental plaque.6, 7, 8 These pathogens can be aspirated into the lungs and cause infection.8

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

REFERENCES: 1. Mangram AJ, et al., Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention, Hospital Infection Control Practices Advisory Committee, Atlanta GA. 2. Stone PW, Braccia D, Larson E, Am J Infect Control. Nov 2005;33(9):501-9. 3. Kirkland KB, et al., Infect Control Hosp Epidemiol. Nov 1999;20(11):722-4. 4. Schleder B, et al., J Advocate Health Care. 2002 Spr/Sum;4(1):27-30. 5. Tablan OC, et al., Guidelines for preventing health-care associated pneumonia, 2003, Recommendations of CDC and Healthcare Infection Control Practices Advisory Committee (HICPAC), 2003. 6. Scannapieco FA, J Periodontology.1999 Jul;70(7):793-802. 7. Scannapieco FA, et al., Crit Care Med. 1992 Jun;20(6):740-5. 8. Fourrier F, et al., Crit Care Med. 1998;26:301-8.

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
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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
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Chlorhexidine reduces infections in knee arthroplasty
Johnson A, Kapadia B, Dailey J, Moline C, Mont M
Journal of Knee Surgery, June 2013
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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
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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.
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Perioperative Antisepsis Protocol Initiative
Thompson B
APIC 2014
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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
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An Orthopaedic Surgical Decolonization Protocol
Story A
University of Missouri Healthcare Preliminary Results Hip and Knee
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The Effect of Universal Intranasal Povidone Iodine Antisepsis on Total Joint Replacement Surgical Site Infections
Brown L
Poster presented at APIC 2014
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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
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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
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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
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Drop a Bundle and Save: Reducing Surgical Site Infections Across Surgical Populations
Farber M
(NTI) Natonal Teaching Institute & Critical Care Expositon: May 15-20, 2010
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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
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A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals
SHEA 2014
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Guide to the Elimination of Orthopedic Surgical Site Infections
APIC 2010
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Guideline for the prevention of surgical site infection, 1999
CDC
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Using Sage Products’ Chlorhexidine Gluconate Cloths Preop May Prevent SSI and MRSA
Advance Healthcare Network for Nurses
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Small Changes, Big Results An initiative at Prince William Hospital to reduce surgical site infections yields significant returns
Bonnie Harris
Advance for Nurses
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