Challenges and Experience with Implementing Patient Preoperative Skin Preparation in a Veterans Administration (VA) Health System To Prevent Surgical Site Infections

Abstract

ISSUE: Nurses at a VA health system had difficulty educating patients on preoperative skin preparation, and use of a chlorhexidine gluconate (CHG) formulation available only via the pharmacy. Challenges of educating patients on preoperative skin preparation fell to pharmacy staff. The surgical site infection (SSI) rate for 2005 was 0.2%, and the health system recognized the importance of proper preoperative skin preparation and education in prevention of SSIs, as well as the effective role appropriate skin preparation plays in SSI prevention. It was noted education may be more effective if provided by nursing staff. Process improvement was aimed at enhancing education of patients without access to showers, who were often homeless, and had difficulty getting into a shower due to poor health (20,524 patients age $60; 9,558 living in poverty and qualify for free care; 1,421 housebound). The preoperative protocol was rewritten and implemented.