Preoperative Shower Research Articles

Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure.

Programa de Reducción de la Infección Quirúrgica del Observatorio de Infección en Cirugía (PRIQ-O). Documento de priorización y consenso Delphi de recomendaciones para la prevención de la infección de localización quirúrgica

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure.

Antibiotic Use, Incidence and Risk Factors for Orthopedic Surgical Site Infections in a Teaching Hospital in Madhya Pradesh, India.

Orthopedic surgeries contribute to the overall surgical site infection (SSI) events worldwide. In India, SSI rates vary considerably (1.6–38%); however, there is a lack of a national SSI surveillance system. This study aims to identify the SSI incidence, risk factors, antibiotic prescription and susceptibility patterns among operated orthopedic patients in a teaching hospital in India. Data for 1205 patients were collected from 2013 to 2016. SSIs were identified based on the European Centre for Disease Prevention and Control guidelines. The American Society for Anesthesiologists classification system was used to predict patients’ operative risk. Univariable and multivariable backward stepwise logistic regressions were performed. Overall, 7.6% of patients developed SSIs over three years. The most common SSIs causative microorganism was Staphylococcus aureus (7%), whose strains were resistant to penicillin (100%), erythromycin (80%), cotrimoxazole (80%), amikacin (60%) and cefoxitin (60%). Amikacin was the most prescribed antibiotic (36%). Male sex (OR 2.64; 95%CI 1.32–5.30), previous hospitalization (OR 2.15; 95%CI 1.25–3.69), antibiotic prescription during hospitalization before perioperative antibiotic prophylaxis (OR 4.19; 95%CI 2.51–7.00) and postoperative length of stay > 15 days (OR 3.30; 95%CI 1.83–5.95) were identified as significant risk factors. Additionally, preoperative shower significantly increased the SSI risk (OR 4.73; 95%CI 2.72–8.22), which is unconfirmed in the literature so far.

Economic evaluation of pre-operative shower with antiseptic soap to prevent surgical site infections

A pre-operative shower is recommended before surgery to prevent surgical site infections (SSIs). We modelled the occurrence of SSIs and the potential savings for patients undergoing an antimicrobial soap (AS) shower prior to surgery at a French University Hospital level. AS shower prevented 209 SSIs, generating a potential saving of €632,210 per year. Results grouped by type of surgery showed annual savings of €26,537, €20,520 and €14,377 for orthopaedic, gynaecologic and obstetric, and digestive surgery, respectively. Despite the lack of published data surrounding the efficacy of AS in preventing SSIs, we demonstrated the potential savings and benefits of generalizing AS before surgical interventions.

The preoperative shower for obese patients: What patients and caregivers say

Introduction: At least one preoperative shower is recommended to avoid surgical site infection. Caregivers must explain the showering technique, help the patient if necessary, and assess skin cleanliness after showering.Context: Showering may be more difficult for obese patients because of inadequate equipment and difficulties moving, as well as insufficient explanation regarding the showering technique and an insufficient skin cleanliness assessment from caregivers.Objective: to assess whether patients and/or caregivers report difficulties in the preoperative shower process that could be linked to patient obesity. Methods: pilot qualitative survey with semi-structured interviews conducted with 9 obese surgery patients and 11 surgery caregivers.Results: Patients did not report feelings of discrimination. They described no problem with equipment, but declared having received little explanation on the showering technique and no visual skin cleanliness assessment. Caregivers reported equipment as inadequate, they stated having delivered detailed information, but found the skin cleanliness assessment difficult.Discussion: The lack of skin cleanliness assessment by caregivers after preoperative showering is new information. Limits: preliminary study with a small number of interviews and no non-obese patients.Conclusion: the subject warrants additional work with both quantitative and qualitative surveys to better understand the difficulties with preoperative showering.

Interrupted time series analysis of the impact of a bundle on surgical site infections after colon surgery

Surgical site infections (SSIs) are monitored in Italy through a national surveillance system. A 4-element bundle was introduced in 2012, consisting of: appropriate preoperative shower and hair removal, perioperative normothermia, and antibiotic prophylaxis. The aim of this study was to evaluate the effect of the intervention on SSI rates after colon surgery. A retrospective cohort study was conducted between 2008 and 2019 in 29 hospitals of northern Italy. An interrupted time series analysis (ITSA) was modeled to assess the bundle's impact on SSI trends. Logistic regression was performed to identify predictors of SSI among procedures performed in the postintervention period, comparing full and partial bundle compliance. Data of 5487 colon surgery procedures were collected (1243 preintervention and 4244 postintervention). The ITSA identified a significant change in the monthly postintervention SSI trend of -0.19% and a change in level of -2.09%. A significant protective effect of full bundle compliance compared to partial bundle compliance (OR 0.74, P.043) was found, whereas the single effect of the bundle elements was nonsignificant. Results of this study suggest this relatively simple bundle protocol is effective in reducing SSI risk.

A Care Bundle Intervention to Prevent Surgical Site Infections After a Craniotomy.

Although surgical site infections after a craniotomy (SSI-CRANs) are a serious problem that involves significant morbidity and costs, information on their prevention is scarce. We aimed to determine whether the implementation of a care bundle was effective in preventing SSI-CRANs. A historical control study was used to evaluate the care bundle, which included a preoperative shower with 4% chlorhexidine soap, appropriate hair removal, adequate preoperative systemic antibiotic prophylaxis, the administration of 1 g of vancomycin powder into the subgaleal space before closing, and a postoperative dressing of the incisional surgical wound with a sterile absorbent cover. Patients were divided into 2 groups: preintervention (January 2013 to December 2015) and intervention (January 2016 to December 2017). The primary study end point was the incidence of SSI-CRANs within 1 year postsurgery. Propensity score matching was performed, and differences between the 2 study periods were assessed using Cox regression models. A total of 595 and 422 patients were included in the preintervention and intervention periods, respectively. The incidence of SSI-CRANs was lower in the intervention period (15.3% vs 3.5%; P < .001). Using a propensity score model, 421 pairs of patients were matched. The care bundle intervention was independently associated with a reduced incidence of SSI-CRANs (adjusted odds ratio, 0.23; 95% confidence interval, .13-.40; P < .001). The care bundle intervention was effective in reducing SSI-CRAN rates. The implementation of this multimodal preventive strategy should be considered in centers with high SSI-CRAN incidences.

Bacterial skin recolonization in the operating room: comparison between various antisepsis protocols

Surgical site infection (SSI) largely implicates the patient's endogenous skin microbiota. Perioperative disinfection protocols do not follow a general agreement. To compare antisepsis and skin protection protocols on quantitative analysis of recolonization in the operating room at regular time-steps. The study hypothesis was that one protocol would be more effective than others. A single-centre prospective interventional study was conducted between January and June 2019. Healthy volunteers were randomized between protocols and served as their own controls. The protocols began ahead of scheduled orthopaedic surgery with a preoperative shower, mechanical cleansing, application of major antiseptics (alcoholic Bétadine™ 5% or alcoholic chlorhexidine 0.5%), sterile draping, then adhesive draping (3M™ Steri-Drape™ or iodine-impregnated 3M™ Ioban2™). Sampling was by swabbing in the operating room at 30 min intervals up to 90 min after draping. Cultures were performed under aerobic and anaerobic conditions. Qualitative and quantitative (cfu/mL) bacteriology was performed in the laboratory by direct reading on the blood agar plates. Thirty subjects were included; none was lost to follow-up or excluded from analysis. Bacterial load before manipulation (T0) was significantly higher in males (P < 0.0001) despite a significantly shorter shower-to-sampling interval (P= 0.03). Smoking (P= 0.85), body mass index (P= 0.38), and depilation (P= 0.50) did not significantly affect preoperative load. Mean load increased significantly under all protocols up to T90 min, without significant superiority for any one protocol. Associated Bétadine™/Ioban™ showed the lowest T90 load, and chlorhexidine alone the highest, but without significant difference. Isolates at T0 were predominantly healthy skin commensals: coagulase-negative staphylococci, micrococci, and coryneforms. No one protocol demonstrated superiority, whether in immediate bactericidal action or in preventing skin recolonization in the operating room. Further studies are needed to define generally agreed protocols for SSI risk management.

Implementation of a comprehensive unit-based safety program to reduce surgical site infections in cesarean delivery

To evaluate whether using a comprehensive and multidisciplinary approach to implement an evidence-based bundle can reduce 30-day surgical site infection rates in women undergoing cesarean delivery. This observational study with a preintervention and postintervention design included 2576 consecutive women undergoing cesarean delivery at our tertiary care hospital between January 1, 2013 and December 31, 2017. The primary outcome was 30-day surgical site infection rate after cesarean delivery defined according to the Centers for Disease Control and Prevention criteria. The preintervention period span from the January 1, 2013 to December 31, 2014. After initiation of a Comprehensive Unit-based Safety Program (ie, a continuous quality improvement program to improve patient safety using a comprehensive and multidisciplinary approach adapted on local demands), we introduced a bundle of evidence-based interventions (including preoperative shower, hair removal with clippers, correct antibiotic prophylaxis, maintaining normothermia, glycemic control, and strict compliance with hygiene standards as well as practice good hand hygiene) per January 1, 2015 into clinical routine. The postintervention period span from January 1, 2015 to December 31 2017. In the preintervention period the overall surgical site infection rate was 16 of 1,060 cesarean deliveries versus in the postintervention period the overall surgical site infection rate was 9 of 1,516 cesarean deliveries (1.50% vs 0.56%; P = .033). This corresponds to a relative risk reduction of over 60% after implementation of the evidence-based bundle (odds ratio 0.39, 95% confidence interval 0.17-0.89; P = .020). In the present study, we have adapted the Comprehensive Unit-based Safety Program strategy to implement an evidence based-bundle into clinical routine. Using this comprehensive and multidisciplinary approach, we could markedly reduce 30-day surgical site infections.

Hand surgery in a clinic setting using ultrasound percutaneous procedure: A review of 900 procedures

Introduction With local anesthesia and new ultrasound-guided percutaneous procedures, it is now more often possible to perform hand surgery in minimal settings. Indeed, the authors argue that most hand surgery procedures could be performed in office surgeries. They have reported morbidities in a continuous series of 921 ultrasound-assisted hand procedures performed under local anesthesia in a clinic setting. Method Over a period of 3.5 years, 921 in-office procedures (635 patients) were performed using specific ultrasound-guided techniques (previously published) under local anesthesia. We included 265 trigger fingers, 418 carpal tunnel releases, 25 de Quervain releases and 202 Dupuytren contractures, 3 lateral epicondylitis, 8 flexor tendon sheath ganglions. Exclusion criteria for office surgery were: – ASA (American Society of Anesthesiologists) grade 3 or higher; – allergic history (latex, xylocaine?); – age over 85. Asepsis was achieved with a preoperative iodine shower and a 5-step antiseptic skin preparation. Fasting was forbidden and disease-modifying treatments, including anticoagulants, taken as usual. The WALANT technique was used for local anesthesia. All procedures were performed percutaneously under ultrasound guidance. Surgical blades were proscribed, only a 18 gauge needle was used for skin incision. All the instruments were thinner than 1.5 mm, non-disposable and cost less than 50? Bandages were removed by the patient the day after surgery. Morbidities were reported systematically: – before surgery, during local anesthesia (vagal faintness, panic attack); – during surgery (pain, excessive bleeding, faintness, mild heart attack); – after surgery (infection, Sudeck's disease, hematoma, scarring problem). Individual procedure efficacy was assessed in previous studies and not included in this series. Results Preoperative: – 18 vagal faintness, including 5 syncopes with spontaneous resolution; – no panick attack. Operative: – no pain felt; – no excessive bleeding, no specific hemostasis procedure needed; – no heart attack. Postoperative: – 1 infection in a trigger finger requiring re-operation; – 19 Sudeck's disease; – 10 mild hematoma after carpal tunnel release with spontaneous resolution. Conclusion The combination of the WALANT technique and ultrasound-assisted procedures provides an original approach that can be used in a clinic setting. Three vagal faintness (without syncope) was observed in the last 400 patients. The morbidities reported were at least equivalent to those published in standard operating theatre procedures; only one patient was re-operated (case of infection). Hand surgery can be performed in good conditions as in-office surgery using local anesthesia and ultrasound guidance.

What interventions are performed in daily practice to prevent surgical site infections in neurosurgical patients? Findings from an explorative survey

Aim The primary aim of the study was to describe the perioperative care ensured on a daily basis to prevent surgical site infection in Italian neurosurgeries; the secondary aim was to explore surgical site infections 30 days after the surgical procedures. Methods Patients cared for in 16 neurosurgical units who (a) were ≥18 years of age, (b) underwent neurosurgical procedures, and (c) were willing to participate in the study were taken into account. Results A total of 383 patients were included. A preoperative shower was performed in 332 cases (86.7%), shaving in 318 (83%) cases, and antibiotic prophylaxis was administered in 293 (76.5%) cases. Surgical site disinfection was performed mainly with povidone–iodine (344; 89.8%). A surgical site dressing was applied in 376 (98.2%) cases and was changed on average after 37.8h for shaved and 39h for non-shaved patients. Postoperative shampooing was performed only in 74 (19.3%) cases. Surgical site infection at 30 days occurred in three (0.8%) patients. Discussion and conclusions: Perioperative care aimed at preventing surgical site infections is variable across Italian neurosurgical units. More studies aimed at developing evidence capable of supporting decision-making processes in neurosurgery care are strongly recommended.

Skin preparation for abdominal surgery

Surgical site infections (SSI) are a public health issue. The purpose of this review is to review the literature on methods of pre-operative skin preparation for the prevention of SSI in abdominal surgery. In order to obtain the best level of evidence, only meta-analyses and randomized controlled clinical trials were selected from the Cochrane Library and PubMed databases. High-powered non-randomized studies were included when results were not available for the questions asked. The primary endpoint was the rate of SSI within 30 days. Analysis of the 20 selected studies suggested that hair removal in the operative field is not recommended except when it interferes with surgery; in this case, hair clipping or chemical depilation is recommended and shaving should be banned. For the pre-operative shower, the choice of a detergent product with or without antiseptic does not seem to matter, and there were no published data on the required number of showers or the interval before surgery. Application of an alcohol-based solution to the operative field for cutaneous disinfection is recommended; the products used seem to be equivalent, and there is no need for pre-operative detergent scrubbing. There is no strong evidence to recommend adhesive plastic drapes for clean or contaminated surgery. Some recommendations on skin preparation before abdominal surgery to reduce the rate of SSI are based on a high level of evidence. Other recommendations such as the number and duration of pre-operative showers or use of adhesive plastic skin drapes are less well supported.

Ultrasound-guided percutaneous hand surgery in clinic settings – a review of 513 patients

With local anesthesia and new ultrasound-guided percutaneous procedures, it is now more often possible to perform hand surgery in minimal settings. Indeed, the authors argue that most hand surgery procedures could be performed in office surgeries. They have reported morbidities in a continuous series of 513 ultrasound-assisted hand procedures performed under local anesthesia in a clinic setting. Over a period of 2.5 years, 513 in-office procedures (402 patients) were performed using specific ultrasound-guided techniques (previously published) under local anesthesia. We included 142 trigger fingers, 241 carpal tunnel releases, 25 de Quervain releases and 105 Dupuytren contractures. Exclusion criteria for office surgery were: ASA (American Society of Anesthesiologists) grade 3 or higher allergic history (latex, xylocaine…) age over 85. Asepsis was achieved with a preoperative iodine shower and a 5-step antiseptic skin preparation. Fasting was forbidden and disease-modifying treatments, including anticoagulants, taken as usual. The WALANT technique was used for local anesthesia. All procedures were performed percutaneously under ultrasound guidance. Surgical blades were proscribed, only a 18-gauge needle was used for skin incision. All the instruments were thinner than 1.5 mm, non-disposable and cost less than 50 €. Bandages were removed by the patient the day after surgery. Morbidities were reported systematically – before surgery, during local anesthesia (vagal faintness, panic attack) – during surgery (pain, excessive bleeding, faintness, mild heart attack) – after surgery (infection, Sudeck's disease, hematoma, scarring problem) Individual procedure efficacy was assessed in previous studies and not included in this series. Preoperative – 15 vagal faintness, including 5 syncopes with spontaneous resolution, no panic attack. Operative – no pain felt, no excessive bleeding, no specific hemostasis procedure needed, no heart attack. Postoperative – 1 infection in a trigger finger requiring re-operation, 4 Sudeck's disease, 4 mild hematoma after carpal tunnel release with spontaneous resolution. The combination of the WALANT technique and ultrasound-assisted procedures provides an original approach that can be used in a clinic setting. No vagal faintness was observed in the last 400 patients. The morbidities reported were at least equivalent to those published in standard operating theatre procedures + only one patient was re-operated (case of infection). Hand surgery can be performed in good conditions as in-office surgery using local anesthesia and ultrasound guidance.

Multi-Institution Analysis of Infection Control Practices Identifies the Subset Associated with Best Surgical Site Infection Performance: A Texas Alliance for Surgical Quality Collaborative Project

In an effort to reduce surgical site infection (SSI) rates, a large number of infection control practices (ICPs), including operating room attire policies, have been recommended. However, few have proven benefits and many are costly, time-consuming, and detrimental to provider morale. The goal of this multi-institution study was to determine which ICPs are associated with lower postoperative SSI rates. Twenty American College of Surgeons NSQIP and Texas Alliance for Surgical Quality-affiliated hospitals completed this Quality Improvement Assessment Board-approved study. Surgeon champions at each hospital ranked current surgery, anesthesia, and nursing adherence to 38 separate ICPs in 6 categories (attire, preoperative, intraoperative, preoperative, intraoperative, antibiotics, postoperative, and reporting) on 4-point scales for general surgery cases. These data were compared with the risk-adjusted general surgery SSI odds ratios contained in the July 2016 American College of Surgeons NSQIP hospital-level, risk-adjusted reports. Compliance rates were compared between the 7 best (median SSI odds ratio, 0.64; range, 0.56 to 0.70) and 7 worst (median SSI odds ratio, 1.16; range, 0.94 to 1.65) performers using ANOVA. Nearly all hospitals reported maximal adherence to hair removal with clippers (Surgical Care Improvement Project measure Inf-6) and to best-practice prophylactic antibiotic metrics (Surgical Care Improvement Project measure Inf-1-3). Variable adherence wasidentified across many ICPs and more frequent compliance with 8ICPs correlated withlower SSI odds ratios, including preoperative shower; skin preparation technique; using clean instruments, gowns, and gloves for wound closure and dressing changes; and transparent internal reporting of SSI data. Operating room attire ICPs, including coverage of nonscrubbed provider head and arm hair, did not correlate with SSI rates. This analysis suggests that the subset of ICPs that focus on perioperative patient skin and wound hygiene and transparent display of SSI data, not operating room attire policies, correlated with SSI rates. Implementation of this subset of evidence-based ICPs may improve SSI rates at lower-performing hospitals.

Combination of Oral Antibiotics and Mechanical Bowel Preparation Reduces Surgical Site Infection in Colorectal Surgery

Surgical site infections (SSI) are a common complication after colorectal surgery. An infection prevention bundle (IPB) was implemented to improve outcomes. A standardized IPB that included the administration of oral antibiotics with a mechanical bowel preparation, preoperative shower with chlorhexidine, hair removal and skin preparation in holding, antibiotic wound irrigation, and a "clean-closure" protocol was implemented in January 2013. Data from the American College of Surgeons NSQIP were analyzed at a single academic institution to compare pre-IPB and post-IPB SSI rates. In January 2014, a prospective database was implemented to determine compliance with individual IPB elements and their effect on outcomes. For the 24 months pre-IPB, the overall SSI rate was 19.7%. During the 30 months after IPB implementation, the SSI rate decreased to 8.2% (p < 0.0001). A subset of 307 patients was identified in both NSQIP and our prospective compliance databases. Elements of IPB associated with decreased SSI rates included preoperative shower with chlorhexidine (4.6% vs 16.2%; p= 0.005), oral antibiotics (3.4% vs 15.4%; p < 0.001), and mechanical bowel preparation (4.4% vs 14.3%; p= 0.008). Patients who received a full bowel preparation of both oral antibiotics and a mechanical bowel preparation had a 2.7% SSI rate compared with 15.8% for all others (p < 0.001). On multivariate analysis, full bowel preparation was independently associated with significantly fewer SSI (adjusted odds ratio 0.2; 95% CI 0.1 to 0.9; p= 0.006). Implementation of an IPB was successful in decreasing SSI rates in colorectal surgery patients. The combination of oral antibiotics with a mechanical bowel preparation was the strongest predictor of decreased SSI.

Factors predicting surgical site infection after posterior lumbar surgery: A multicenter retrospective study.

This is a retrospective study.The purpose of this study is to explore incidence and risk factors for surgical site infection (SSI) after posterior lumbar surgery.SSI is a common complication after posterior lumbar surgery, bringing mental and physical pain and prolonging hospital stay. However, predisposing factors, as reported less, remain controversial.Patients who underwent posterior lumbar surgery at 3 centers between 2006 and 2016 were included. The possible factors include 3 aspects: demographic variables-age, sex, body mass index (BMI), waist-to-hip radio (WHR), hypertension, diabetes, heart disease, smoking, drinking, steroidal injection, surgical time between June and September, preoperative shower; blood test variables-white blood cell (WBC), neutrophil, red blood cell (RBC), hemoglobin (Hb), total protein (TP), albumin, albumin/globulin (A/G), C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and surgical related variables-operation time, blood loss, operative level, instrumentation, incision length. Factors related with SSI were also performed by multivariate analysis.The prevalence of SSI was 3.00% (267 cases of 8879) had a postoperative wound infection. There were significant difference in WHR (0.92 vs 0.83), WBC (4.31 vs 6.69), TP (58.7 vs 65.2), albumin (36.9 vs 43.2), CRP (2.01 vs 0.57), PCT (0.097 vs 0.067), operation time (217.9 vs 195.7), blood loss (997.1 vs 915.3) and operative level (3.05 vs 2.45) and incision length (24.1 vs 20.0) between SSI group and non-SSI group. >60 years old, female, BMI <18.5 and >30.0, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, no preoperative shower, instrumentation surgery were risk factors for SSI after posterior lumbar surgery.Many factors, >60 years old, female, BMI, WHR, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, preoperative shower, WBC, TP, albumin, CRP, PCT, operation time, blood loss and operative level, instrumentation surgery and incision length, could predict SSI after posterior lumbar surgery. Measure should be taken before surgery to lower incidence of SSI after surgery.

The "bundle" approach to reduce the surgical site infection rate.

In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted following ECDC recommendations, according to the protocol of the National System of Surveillance of Surgical Site Infections. In 2009, in Piedmont region, where the study was conducted, it was introduced a survey of a "bundle" for every patient under SSIs surveillance. The bundle includes 5 items: infection risk index calculation, preoperative shower, trichotomy, antibiotic prophylaxis, and body temperature control. The aim of this study is the evaluation of the incidence rate of the SSIs in relation to the implementation of the bundle from January 1st to December 31st, 2012. This study is an observational study (retrospective cohort). The regional surveillance system collected 3314 surgical operations during the year 2012 from 37 hospitals. The represented surgical categories were hip prosthetic surgery (HPRO: 1992 cases) and colon surgery (COLO: 1322 cases). The bundle was implemented in 1114 and 671 operations, respectively. Univariate and multivariate analysis were conducted stratifying the sample for hip surgery and colorectal surgery, with the purpose to identify an association between the implementation of the bundle and a decrease of the rate of SSIs. From the analysis, the bundle resulted as a protective factor for the infection risk in colon surgery (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.38-0.78). The main risk factors were American Society of Anesthesiologists score≥3 (OR, 1.57; 95% CI, 1.10-2.24) and contamination class≥3 (OR, 2.02; 95% CI, 1.37-2.97). In the hip surgery, the application of the bundle was not statistically associated to a decrease of the risk of infection. The use of surgical bundle seems to reduce significantly the SSIs rate in the colon surgery.

Risk stratification of surgical site infection in a Tertiary Care Hospital: A prospective case-control study

Introduction: Health care associated infections are preventable cause of morbidity and mortality in healthcare setting. Surgical site infections are no different. It is essential to identify patients who are at high risk of getting SSI and preventive measures instituted even prior to admission for surgery Methods: This study comprising of all the SSIs that we encountered over two years and about 10 to 12 patients (per infected patient ) without infection as 'controls'. These two sets of data was used to identify the weightage of each risk factor using logistic regression. Results: We encountered thirty infections during the years 2015 and 2016, three hundred thirty non infected cases were used as control to arrive the weightage of each factor. Using a backward stepwise multivariate logistic regression model in the whole cohort, body mass index > 30 kg/m2, duration of preoperative stay and use of preoperative antiseptic shower were found to be independent predictors for SSIs. We could predict incidence of SSI with good discrimination (area under ROC curve – 0.855 , 95% confidence intervals 0.81-0.89). Three factors appear to stand out in our study, they are BMI, preoperative stay and preoperative antiseptic shower. These factors appeared to weigh differently in each specialty. Conclusion: The authors are now able assign scores to each of their patients depending on the type of surgery, sex of the patient, body mass index, number of preoperative days in the hospital, and whether chlorhexidine shower was given or not.

Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature.

Chlorhexidine bathing is effective in reducing levels of pathogens on skin. In this review, we examine the evidence that chlorhexidine bathing can prevent colonization and infection with health care-associated pathogens and reduce dissemination to the environment and the hands of personnel. The importance of education and monitoring of compliance with bathing procedures is emphasized in order to optimize chlorhexidine bathing in clinical practice.

Preoperative antiseptic shower for the prevention of surgical site infections is it effective? A systematic review

Aim: Surgical site infections are serious problems in surgical departments for increasing mortality, morbidity, hospitalization duration, and cost. In this study it was aimed to examine high-level evidence studies regarding the effect of preoperative antiseptic showering on surgical site infections. Instrument and Method: 1034 studies published between the years 2005 and 2014 were examined and 17 international publications were included and evaluated in terms of comparison, limitation and results. Findings: It was seen as a result of this systematic examination that some studies reported that preoperative showering or bathing with antiseptic decreased the risk of surgical site infection. It was also revealed that the safety and efficiency of body cleaning products were related to appropriate timing and number of applying them. Besides, it was also seen that the rate of surgical site infection in patients having preoperative shower with chlorhexidine was lower compared to patients using other products. Result: It is thought that preoperative showering in the appropriate time and with appropriate antiseptic solutions might increase the chance of decreasing surgical site infections and contribute to providing quality health service by decreasing the cost. Pam Med J 2016;9(2):171-179