Evidence-Based Practice Poster Session (Posters #21-#28)
21 - Reducing Deep and Organ Space SSI Using Evidence-based Skin Prep Regimen
Description: Clinical Problem: Surgical site infections (SSI) are the most costly hospital-acquired infection (HAI) type and are the most common cause of potentially preventable patient morbidity. Houston Methodist West (HMW) saw an increase in SSI in 2018, leading to an overall SSI increase of 56% in comparison to 2017. Out of the total number of SSIs, 79% were deep or organ space infections and 72% of the cultured organisms were skin-dwelling microorganisms that are present when the surgical incision was made, including Staphylococcus, coagulase-negative staphylococci, and Pseudomonas.
Background: There are three types of SSI - superficial, deep, and organ space. Superficial infections involve only skin and subcutaneous tissue; deep infections involve deep tissue, such as fascial and muscle layers; organ space involve any part of the anatomy in organs and spaces other than the incision. Clinical Question: Will the implementation of skin-prep cleansing regimen influence in the reduction of preventable SSI?Description of EBP: A multi-disciplinary task force found a specific factor contributing to the increased SSI rate. The one consistency found was that the primary organisms cultured from the wounds were skin contaminants. After looking at evidence, the task force agreed to use an adjunct skin cleansing regimen of 4% Chlorhexidine gluconate scrub intraop before surgical skin preparation is performed. The combined skin cleansing regimen is used to reduce the concentration of the transient and resident bacteria on patient's skin thereby limiting the risk of wound contamination. Implementation of EBP: The skin preparation techniques of the OR staff was evaluated to ensure that the staff is following the recommended skin antisepsis set by the AORN guidelines. The OR staff were re-educated on the correct skin preparation techniques and skills validation was done through return demonstration. Education and training performed on the new skin prep regimen. The use of 4% chlorhexidine gluconate scrub for cleaning the skin in combination with the standard alcohol-based solution or 10% povidone-iodine solution is performed in all skin prep except in perineal preps or if allergic.
Results: HMW saw an 86% decrease of skin contaminant related SSI between 2018 and 2019 after the new cleansing regimen was added to skin preparation routine.
Discussion: There is still ongoing SSI statistics and case reviews to be presented and the collaborative team will explore further development of best practice to prevent future SSI at HMW. There are ongoing opportunities for improvement and the SSI task force will consider adopting additional prevention approaches to reduce SSIs. Nursing Implications: The perioperative nurses play a significant role in lowering the patient's risk for SSI by adhering to the recommended skin preparation techniques and following the combined skin prep regimen. The goal of reducing preventable SSIs is achieved through interdisciplinary collaboration.