Monday, June 28, 2010

Pre-Hospital Surgical Prep

 Updated 3/2017 --  all links (except to my own posts) removed as many no longer active.

The June 2010 issue of the Surgical Products magazine has an article by Amanda McGowan focusing on the prep in preventing surgical site infections – Preventing SSI: It Starts in the Prep.

What really caught my attention was the pre-hospital prep described for one hospital.  Currently, (as most of my patients exhibit good hygiene) I haven’t begun anything more than taking a shower (with basic soap), washing their hair, and brushing their teeth pre-op.  My SSI rate is less than 0.5% over 20 years.  The bold is my emphasis.
As Beth Beck, director of infection prevention and control/employee health at Springhill Medical Center in Mobile, AL, explains, her facility follows specific steps in the prep process to help reduce infection risk.
“We ask the surgeons to have the patients bathe with chlorhexidine the night before,” she says.
“Then, once they arrive to the hospital, we wipe them down with a CHG-impregnated cloth and we instruct patients to brush their teeth twice. We have them rinse with a CHG oral rinse. Then, we give them skin and nasal antiseptic.”
Now remember this is a surgical products magazine, so the focus on the article may be to sell me the skin and nasal antiseptic product which the article mentions is marketed by 3M and is meant to reduce Staphylococcus aureus (Staph aureus) colonization, a leading cause of SSI.
The article quotes Joe Gillis, marketing manager for the skin and nasal antiseptic product at 3M:
According to Gillis, approximately thirty percent of surgical patients today are colonized with Staph aureus in the nares. In turn, a study published in The Lancet in 2004 revealed that eighty percent of Staph aureus infections are caused by the patient’s own nasal flora. Additionally, one percent of the surgical population carries methicillan-resistant Staphylococcus aureus (MRSA).
The article goes on to explain that Beck’s facility is in the trial phase of using the skin and nasal antiseptic product on orthopedic patients who are undergoing an operation involving implants.  The hospital added the nasal antiseptic part of the routine after seeing an increase in surgical site infections in orthopedic patients.
What is your or your hospital’s routine “prep before the prep?”

How-to Guide: Prevent Surgical Site Infection
How-to Guide: Reduce Surgical Complications


Chrysalis said...

We have a surgeon here that has his patients use Dial soap.

emt.dan said...

Does this hospital have any data to substantiate this practice? Does it work? Decrease SSI or just waste money?

ER's Mom said...

Nothing specific.

I have had to write shower upon admission orders for some of my laboring patients. :(

rlbates said...

emt.dan, I don't think anyone does yet. I think Ms Beck and her hospital are part of a trial.

Kyla said...

After my daughter's muscle biopsy, she developed a MRSA infection in her incision. We handled this through the pediatrician rather than the surgeon, so would an infection like that be somehow recorded as part of the surgeon's SSI rate if it didn't require re-admission to the hospital?

(I'm a pre-med, I ended up here via another blog I read.)

rlbates said...

Kyla, it would depend on how the pediatrician coded it. Most hospitals and surgery centers rely on the surgeons to report postop complications (this includes infections). Ones handled by the non-operating surgery may actually be missed in the count especially if the pediatrician/family doctor/etc didn't give the surgeon feedback.