Fact: Progressive Skin Prep Regimen Reduces Skin Contaminant Infections

Abstract

Background The hospital was successful in reducing deep and organ space skin contaminant-related surgical site infections (SSI) by using a progressive skin cleansing regimen to reduce the concentration of transient and resident bacteria on the patient's skin. The adjunct procedure limits the risk of surgical site contamination of endogenous skin microbial pathogens. Methods An extensive review determined that the majority of primary organisms cultured from the Hospital Acquired Infections (HAI) were skin contaminate-related. Based on the review and surgeon recommendations, a task force implemented an adjunct cleansing regimen of 4% CHG surgical scrub sponge used PRIOR to 2% CHG “paint”. The combined cleansing regimen is used in addition to the traditional pre-surgical skin prep. The adjunct process reduces the concentration of transient and resident bacteria on the patient's skin, thereby limiting the risk of wound contamination. Further, the O.R. staff's skin preparation competencies were validated through return-demonstration. Just-in-Time education occurred if deviation from evidence-based practice occurred. Results The hospital saw a 68% decrease in the number of skin contaminant-related deep and organ space surgical site infections during the first six months following the initiation of the progressive skin cleansing regimen. Additionally, it was observed that the occurrence of HAIs deviated from the suggested 4% CHG soap and 2% CHG paint skin prep regimen, resulting in skin contaminant-related SSIs. Conclusions Implementing a comprehensive skin prep regimen eliminates the exposures that place patients at higher SSI risk. The goal to reduce/eliminate preventable skin contaminate-related infections and decrease the likelihood of hospital re-admissions following surgery was achieved. The hospital was successful in reducing deep and organ space skin contaminant-related surgical site infections (SSI) by using a progressive skin cleansing regimen to reduce the concentration of transient and resident bacteria on the patient's skin. The adjunct procedure limits the risk of surgical site contamination of endogenous skin microbial pathogens. An extensive review determined that the majority of primary organisms cultured from the Hospital Acquired Infections (HAI) were skin contaminate-related. Based on the review and surgeon recommendations, a task force implemented an adjunct cleansing regimen of 4% CHG surgical scrub sponge used PRIOR to 2% CHG “paint”. The combined cleansing regimen is used in addition to the traditional pre-surgical skin prep. The adjunct process reduces the concentration of transient and resident bacteria on the patient's skin, thereby limiting the risk of wound contamination. Further, the O.R. staff's skin preparation competencies were validated through return-demonstration. Just-in-Time education occurred if deviation from evidence-based practice occurred. The hospital saw a 68% decrease in the number of skin contaminant-related deep and organ space surgical site infections during the first six months following the initiation of the progressive skin cleansing regimen. Additionally, it was observed that the occurrence of HAIs deviated from the suggested 4% CHG soap and 2% CHG paint skin prep regimen, resulting in skin contaminant-related SSIs. Implementing a comprehensive skin prep regimen eliminates the exposures that place patients at higher SSI risk. The goal to reduce/eliminate preventable skin contaminate-related infections and decrease the likelihood of hospital re-admissions following surgery was achieved.