Preoperative Infection Prevention Protocol to Reduce Rate of Surgical Site Infections

Abstract

Background: Survey of procedures performed across all surgical subspecialties at the Iowa City VAMC in FY2018 showed that the rate of 30-day period surgical site infections (SSI) was significantly higher than that of national average. Average cost saving from single deep or organ space SSI and single superficial SSI are approximately $34,407 and $1,000, respectively. SSI places significant financial burden to the healthcare systems and complicates the course of postoperative recovery. Methods: Previously, all patients undergoing surgery at the Iowa City VAMC underwent Chlorohexidine Gluconate (CHG) bath prior to surgery. A new surgical site infection prevention protocol (SSIPP) involving 2% CHG cloths for skin, Povidone Iodine nasal swab, and 0.12% CHG mouth rinse was implemented in October of 2019 (Figure 1,2)). All eligible cases were reviewed since the implementation of the SSIPP. All recorded SSI were categorized into deep/organ space SSI or superficial SSI. This was compared with the rate of SSI recorded before the SSIPP implementation and cost savings were estimated accordingly. Results: From 10/01/2019 to 09/30/2020 a total of 885 eligible cases were reviewed, revealing a total of 3 deep/organ space SSI. This is significantly lower than 15 deep/organ space SSI recorded from 01/01/2018 to 12/31/2018 out of 1042 cases (p=0.016). However, rate of superficial SSI from 10/01/2019 to 03/30/2020 was significantly different from that of 2018 (p=0.80). Compared to 2018, estimated total cost savings from reductions in deep/organ space SSI ($516,105 vs $258,052) and superficial SSI ($9,000 vs $6,000) approximates to $415,884. Conclusion SSI is a known surgical complication that places significant financial burden on healthcare systems and puts patients at greater risk of postoperative mortality and morbidity. Preoperative infection prevention protocol involving CHG cloths, Povidone Iodine swab, and CHG mouth rinse has significantly decreased the overall rate of SSI and those that involve deep/organ space SSI. This approximates to total cost savings of $415,884 at no cost to the patient.