Antiseptic Procedures Reduce Surgical Site Infections

Evidence-based protocols that are easy to follow and relatively low in cost can reduce surgical site infections (SSIs) by more than 60% for patients who undergo colorectal procedures, according to a new study.

Researchers at Cedars-Sinai Hospital (Los Angeles, CA, USA) collaborated in a quality improvement project that measured SSI rates from March 2011 to March 2012. The project involved several new steps to guard against infections: (1) Patients used chlorhexidine antiseptic solution to shower the evening and morning before surgery. (2) Surgical teams prepared operative sites with a sterile chlorhexidine and alcohol antiseptic solution prior to surgery; after surgery, patients were bathed with chlorhexidine wipes daily. (3) Antibiotics used immediately prior to surgery were standardized, allowing only those from a short list of appropriate alternatives. For operations lasting more than four hours, a second dose of antibiotics was administered to reduce infection risk. (4) Use of wound protectors was encouraged to reduce contamination of the skin while handling the intestines. (5) After completing the contaminated portion of colorectal procedures, members of surgical teams changed to new gowns and gloves, used new instruments, and redraped operative sites with sterile covers. This reduced contamination of the abdomen and skin during surgical closing procedures. (6) The technique of daily wound probing was broadly applied in some cases of wounds considered to be at high risk for infection. This involved a simple and inexpensive daily process using cotton-tipped applicators to release contaminated fluid trapped in wounds.
As a result of these steps and others, the rate of postoperative SSIs after colorectal surgeries dropped from a baseline of 15% to less than 5% within six months. Infection rates continued to decline after the initial rollout of the protocol, remaining well below 5% through July 2012, which is the most recent data available.

“Lower infection rates translate into fewer visits to the emergency department, fewer hospital readmissions, and less need for subsequent operations,” said Rekha Murthy, MD, director of hospital epidemiology at Cedars-Sinai. “This work marks a significant step toward achieving Cedars-Sinai's goal of zero hospital-acquired infections. It represents the first of several projects to eliminate post-op infections.”

Cedars-Sinai conducted its test as part of a larger US national research project on SSIs piloted at seven large hospitals across the country, including Stanford University Medical Center and the Mayo Clinic. Under the collaborative, coordinated by the Joint Commission Center for Transforming Healthcare (Oakbrook Terrace, IL, USA), the hospitals each worked to develop a protocol to dramatically reduce SSIs among patients who underwent colorectal procedures.

Related Links:
Cedars-Sinai Hospital
Joint Commission Center for Transforming Healthcare