Increasing antimicrobial resistance patterns of community and nosocomial uropathogens

Abstract

ISSUE: Cutaneous organisms are the most common pathogens found among the estimated 500,000 surgical site infections that occur annually in the United States. A pre-surgical wash with a chlorhexidine gluconate–containing product and avoiding skin shaving are two widely recognized methods of reducing cutaneous flora. Teaching patients these methods is an important, yet challenging, endeavor for a facility that performs approximately 32,200 surgical procedures annually. PROJECT: Infection control proposed that patients receive two packets of a chlorhexidine gluconate product ($0.64 per patient) provided by the hospital for pre-operative use per Centers for Disease Control and Prevention (CDC) guidelines. A group was formed to rewrite the existing pre-operative education sheet. Education instructions were revised to instruct patients to avoid shaving their surgical site and to wash their surgical site on the evening prior to and the morning of surgery. A Spanish-language version was also written. A simple showering instruction card was printed to allow for various levels of education, utilizing both pictures and words. All outpatient pre-operative assessment areas were given updated information on the preoperative education form, showering instruction cards, and packets of chlorhexidine gluconate product. The inpatient nurse educators were also educated to accommodate the inpatient pre-surgical population. RESULTS: Patient education began in June. In the 6 months following, approximately 8273 patients have received chlorhexidine gluconate wash and “do not shave” instructions. This accounts for 100% of all applicable surgical patients (excludes non-incisional surgery) admitted on an outpatient basis in this period. LESSONS LEARNED: Successful patient education strategies must be simple, cost-effective, and incorporated into existing processes. Administrative support is crucial when a new cost is involved. Interdisciplinary collaboration is also an important component of launching a new patient education campaign. Involvement of physicians, pre-assessment nurses, and nurse educators is the key to success.