E. T. Vo1,2, C. N. Robinson1,2, D. M. Green1,2, B. L. Ehni1,2, P. Kougias1,2, A. Lara-Smalling2, N. Logan2, S. S. Awad1,2 1Baylor College Of Medicine,Department Of Surgery,Houston, TX, USA 2Michael E. DeBakey Veterans Affairs Medical Center,Department Of Surgery,Houston, TX, USA
Introduction: Surgical site infections (SSIs) are associated with an increase in postoperative length of stay, cost, unplanned readmissions, and mortality. Despite adherence to Surgical Care Improvement Project (SCIP) criteria, the rate of SSIs remains high. Therefore, several efforts have been directed towards preoperative strategies to reduce SSIs. We have previously demonstrated that a decontamination protocol using chlorhexidine gluconate (CHG) washcloths and intranasal povidone-iodine (PI) is effective in decreasing SSIs in patients undergoing elective orthopedic surgery. Our objective was to determine the impact of this decontamination protocol on SSIs in patients undergoing elective surgery across four surgical services.
Methods: A retrospective review of a prospectively maintained database was used to identify patients undergoing elective surgery from 2013 to 2015. The preoperative decontamination protocol consists of patients watching an educational video on decontamination at the preoperative visit and applying the CHG washcloths and oral rinse the night before and the morning of surgery, and the intranasal PI the morning of surgery. Participating services included general surgery (GS), neurosurgery (NS), orthopedic surgery (OS), and vascular surgery (VS). Widespread implementation of this protocol at our center began in 10/2014. Rates of SSI were captured through the Veterans Affairs Surgical Quality Improvement Program from 10/2013 to 6/2014 during the pre-intervention period and from 10/2014 to 6/2015 during the post-intervention period. Outcomes were compared by wound class (clean vs. clean contaminated) and by surgical specialty. During the entire study period, there were no differences in patient management or SCIP compliance. Univariate analysis was performed using chi-square.
Results: A total of 4952 cases were evaluated (pre=2529, post=2423), of which 1682 were OS (pre=805, post=877), 1483 GS (pre=737, post=746), 941 VS (pre=534, post=407), and 846 NS (pre=453 post=393). Clean cases totaled 4194 (pre=2125, post=2069) and clean contaminated cases totaled 758 (pre=404, post=354). Overall, the SSI rate was significantly lower in the intervention group (pre=1.6% vs. post=0.9%; P=0.03). By surgical specialty, there was a significant decrease in SSIs in OS (pre=1.4% vs. post=0.3%; P=0.02) and a trend towards lower SSI rates in GS (pre=2.3% vs. post=1.9%; P=0.56), VS (pre=1.5% vs. post=0.5%; P=0.14), and NS (pre=1.1% vs. post=0.8%; P=0.57). By wound class, there was a significant decrease in SSIs in clean cases (pre=1.1% vs. post=0.4%; P=0.01), and a trend towards lower SSI rates in clean contaminated cases (pre=4.2% vs. post=3.7%; P=0.71).
Conclusion: Our data demonstrates that widespread implementation of a preoperative decontamination protocol decreases SSIs among patients undergoing elective surgery, specifically for surgeries with a clean wound class. This protocol may be a preventative strategy for SSIs and warrants further study.