A. J. Rios-Diaz1, G. Chevrollier1, H. Witmer2, C. Schleider1, M. Pucci1, S. Cowan1, F. Palazzo1 1Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA 2Thomas Jefferson University,Sidney Kimmel Medical College,Philadelphia, PA, USA
Introduction: Joint Commission (JC) recommendations mandate the prohibition of the use of surgical skull caps in favor of bouffant and helmet headwear. In the second half of December 2015, this was implemented at our institution with the theoretical goal of decreasing surgical site infections (SSIs). However, supporting data are limited and have been questioned in recent studies and by our departmental leadership. We aimed to assess the impact of this intervention on SSI occurrence at our institution.
Methods: Using our institutional American College of Surgeons National Surgical Quality Improvement Program (NSQIP) General and Vascular procedure-targeted data, we identified patients undergoing any surgical procedure classified as clean or clean-contaminated during a twelve-month period before and after implementation of the surgical headwear policy. Patients without complete 30-day follow up were excluded. Cases with active infection at the time of operation were excluded. Vascular surgery operations were excluded due to the implementation of a separate intervention to decrease SSIs during the study period. Patients were grouped according to timing of the operation in relation to policy change (before or after). Descriptive statistics focused on proportions, and adjusted logistic regression models were used to investigate the association of alternative headwear use with any type of SSI. Models were adjusted for potential confounders that included demographics and clinical characteristics (age, gender, race/ethnicity, obesity, diabetes, steroid use, smoking status, cancer, procedure urgency, wound classification). Statistical significance was set at p < 0.05.
Results: There were 1,901 patients undergoing 1,950 procedures during the study period with 767 (39.3%) before and 1183 (60.7%) after the headwear policy measure was adopted. The most common procedures overall were colectomy (18.2%), pancreatectomy (13.5%) and ventral hernia repair (9.9%). The overall rate of any SSI was 5.4%, with no difference before and after policy implementation (5.3% vs. 5.5%; p=0.81). SSIs by type were also comparable (see the Table). Multivariate analysis controlling for age, gender, race/ethnicity, obesity, diabetes, smoking status, steroid use, cancer diagnosis, and type of wound classification showed no association between implementation of this new policy and SSI occurrence (Odds Ratio 1.12 [95% Confidence Interval 0.74-1.72]; p=0.57).
Conclusion: At our institution, the strict implementation of bouffant and helmet headwear with removal of skull caps from the operating room was not associated with decreased SSIs for clean and clean-contaminated cases. These data question the validity of this JC guideline.
