Key Points in the CDCʼs Surgical Site Infection Guideline

Peri-Operative Method of Applying Chlorhexidine and Iodine as Skin Preparation Solutions: Does It Matter? A Literature Review

Background: Surgical site infection (SSI) is an adverse event that can lead to increased pain, increased cost, risk of death, and decreased patient satisfaction. Studies have investigated the best solutions to prevent SSI. Chlorhexidine has been suggested as the most efficacious antiseptic. However, scant data exist on application of antiseptic solutions and effectiveness of concentric versus back-and-forth strokes. Because a specific method may result in better outcomes, we aimed to review the literature to compare these two techniques. Methods: PubMed-indexed articles were reviewed using specific keywords, including "back-and-forth," "concentric circle," "chlorhexidine," "iodine," "surgical site infection," "antiseptic," and "skin preparation." Because data showing the correlation between SSI and application method of skin preparation solutions were scant, studies that described skin preparation method but analyzed other types of infection, bacteremia, or colonization were also included in this review. Results: No consensus was found regarding the application method. Two articles showed the superiority of chlorhexidine applied using the back-and-forth technique, whereas one demonstrated the superiority of iodine applied in concentric circles. Conclusions: The method of applying antiseptic solution may be just as important as the choice of solution. More studies are needed to assess method of antiseptic application.

Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database

OBJECTIVES

Surgical site infections (SSIs) result in significant negative clinical and economic outcomes. The objective of this study is to estimate annual health expenditures associated with spinal cord stimulation (SCS)-related infections.

MATERIALS AND METHODS

Data from the Truven MarketScan® databases were used to identify patients with an SCS implant (2009-2014) and a continuous health plan enrollment for at least 12-months before and after implant (index date). Annual expenditures were estimated for patients with a device-related infection vs. those without infection since index date. A generalized linear model estimated annual expenditures attributable to device-related infection. Multivariable expenditure models were conducted separately for patients in initial and replacement groups, controlling for demographics, comorbidities, and clinical characteristics.

RESULTS

The study included 6615 patients. Multivariable expenditure models revealed that patients with infection have higher annual expenditures than patients without infection. Estimated incremental annual healthcare expenditures for patients with an infection were $59,716 (95% CI: $48,965-$69,480) for initial implanted patients and $64,833 (95% CI: $37,377-$86,519) for replacement patients. Only 26% of patients who were explanted for infection underwent a reimplant.

CONCLUSIONS

These results show the substantial expenditure burden associated with an SCS-related infection. Management of SCS-related infection is important from both clinical and economic standpoints. The economic and clinical data presented here reinforce the need for additional research and strategies for healthcare providers to minimize SCS infections. Future economic research is needed to further define the specific economic cost drivers associated with the extensive expenditure burden.

The right skin preparation technique: a literature review

Recent debates and guidelines are suggesting back and forth motion to be the optimal preoperative technique for skin preparation. There is a lack of conclusive evidence showing this to be the case, but it may be reasonable to follow this technique, in preference to the widely used concentric circles motion, as the antiseptic agent will reach deeper cell layers of the skin where most of the microbes are found.

Presurgical skin preparation with a novel 2% chlorhexidine gluconate cloth reduces rates of surgical site infection in orthopaedic surgical patients

BACKGROUND

Postoperative surgical site infections (SSIs) are a common complication of joint surgery. Prevention depends on adequate preoperative skin antisepsis. In previous studies, use of a 2% chlorhexidine gluconate (CHG) no-rinse cloth reduced SSI rates in general surgery patients.

METHODS

Patients admitted for a total joint procedure used a skin antisepsis protocol incorporating 2% CHG no-rinse cloths to do a site-specific wash on the night before surgery and in the holding area just before surgery.

RESULTS

In the 3 quarters before implementation of the protocol, the SSI rate was 3.19%. In the 3 quarters after the 2% CHG cloth was introduced, the SSI rate decreased to 1.59%, representing a 50.16% reduction in SSIs.

CONCLUSIONS

The rate of SSI was cut in half after the introduction of 2% CHG no-rinse cloths in the place of a povidone-iodine (Betadine) skin antiseptic in orthopaedic patients undergoing total joint procedures. Further testing using randomization comparative protocols are required to conclude that the decreased SSI was in fact a direct result of the 2% CHG protocol.

PREVENTING SURGICAL-SITE INFECTIONS After Coronary Artery Bypass Graft

Home health nurses play a key role in teaching, assessing, and caring for patients who are at risk for infection. The need for preventing surgical-site infections in patients after bypass is paramount. The incidence, impact, surveillance, and prevention of infection are discussed, along with guidelines to assist the home health nurse in practice.