Devices & Technology

Pre-op Cleansing Reduces Surgical Site Infections


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By Debra Wood, RN, contributor

The simple step of cleansing the skin with chlorhexidine gluconate no-rinse cloths, before surgery, can decrease surgical infection rates. That was the finding of Prince Williams Hospital in Manassas, Virginia, where surgical infection rates decreased by 66 percent and the hospital saved nearly $350,000 in 10 months.

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Studies show that cleansing the skin with chlorhexidine gluconate no-rinse cloths, before surgery, can dramatically decrease surgical infection rates.

"It's easy to use," says Bonnie Harris, a certified in infection control nurse and director of infection control at Prince Williams Hospital. "The pre-op nurses do a lot of education when they do this. It makes patients feel better knowing we are trying to do something to try to prevent infections."

Surgical-site infections cost an average of $25,546 and can add seven to 10 days to a patient's stay. And for infections due to the bacteria methicillin-resistant Staphylococcus aureus (MRSA), the median hospital charge totals $92,363. It's a cost hospitals can ill afford. Starting in October, Medicare will no longer reimburse hospitals for care for mediastinitis related to cardiac surgery. Other surgical-site infections may be targeted in future years as the Centers for Medicare and Medicaid Services aims to improve quality by not reimbursing for preventable errors.

Prince Williams Hospital participated in the Institute of Health Improvement's (IHI) 5 Million Lives Campaign, instituting all of the interventions recommended by the IHI Surgical Care Improvement Project (SCIP) that applied to Prince Williams Hospital: not shaving the operative area, maintaining normal body temperature and using prophylactic antibiotics. The hospital does not perform cardiac surgery. But the rates still weren't where the hospital aimed.

"[The rate] was slowly creeping up over time," Harris said. "With all drug-resistant organisms we were seeing, we knew if we didn't do something it could become a big issue for us."

In September 2006, the hospital began using the Sage 2% Chlorhexidine Gluconate (CHG) Cloths. The product is effective against a broad spectrum of organisms, including MRSA, vancomycin-resistant enterococcus and acinetobacter. The hospital's surgical-site infection rate was 2.1 percent during the preceding 10 months. Twenty-five infections occurred.

When patients come in for surgery, nurses inform them about the importance of pre-op cleansing. The patients are given the two warm, disposable cloths. They use the first to wipe from the chin down, for about 30 seconds, and the second to wipe the surgical area. The skin air dries. No rinsing is needed, and the patient is instructed not to apply lotions or anything to the skin. The patient then signs a form documenting the cleansing was done.

"The nursing staff can make a difference," Harris said. "They were on board with SCIP and with this."

A nurse or a family member will do the pre-op washing for inpatients unable to perform the procedure. Patients allergic to CHG do not perform the cleansing and that is documented. During the past 17 months, one patient refused, which the nurses documented.

In the 10 months after implementing use of the CHG cloths, Prince Williams Hospital's surgical-site infection rate decreased to 0.7 percent, with 11 infections.

Harris estimated the $348,923 financial savings by multiplying the average cost of a surgical-site infection by the number of cases 10 months before and after implementation, and then subtracted the $13,000 expense for the antisepsis product.

The study also found an 83 percent reduction in organisms cultured from surgical sites. The data includes all surgeries, even trauma cases, which did not allow time for pre-op cleansing.

"The nurses have a great sense of satisfaction, knowing they've decreased infections, and they are not seeing as many come back for incision and drainage [procedures]." Harris said. "They take a lot of pride in this."

© 2008. AMN Healthcare, Inc. All Rights Reserved.

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