Outpatient Chlorhexadine Scrubs Help Hospital Reduce Surgical Site Infections

ORLANDO—A pilot program that instituted some small changes, including use of chlorhexadine scrubs the evening before surgery and then again 12 hours later on the morning of surgery, was able to reduce surgical site infections in one Ohio cancer center by almost 20% after 12 months.

“Oncology patients are immunocompromised due to chemotherapy and radiation therapy, and they often have many comorbidities. These factors increase the risk of surgical site infections and poor wound healing,” Lisa Parks, MS, RN, CNP, a surgical oncology nurse at Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio States University, in Columbus, told The Oncology Nurse-APN/PA.

“The guidelines from the Centers for Medicare & Medicaid Services stipulate that a hospitalization that is complicated by a surgical site infection will not be reimbursed, so not only is reducing surgical site infections important for the patient, it’s important for the hospital as well,” she said.

Parks and her coauthor Meghan Routt, RN, MSN, GNP/ANP, also of the James Cancer Hospital, presented the results of their pilot study in a poster session.

Parks and Routt discovered that their center was not complying with the established literature that had been published in the area of surgical site infection prevention. “We did a review of the literature and identified areas that we were not complying with in terms of the established standard. Once we identified those areas, we came up with a plan to try to improve outcomes in those areas, and then we implemented the areas within our division of surgical oncology, and then looked at the results,” Parks explained.

In addition to the chlorhexadine scrubs, they implemented other changes:

• Preoperative shaving was banned because the microscopic cuts that can occur often lead to bacterial proliferation. Instead, clipping was the preferred method of hair removal.
• Antibiotics were ordered to be delivered within 1 hour of surgery to reduce the microbial burden of intraoperative contamination.
• Ertapenem was used in order sets for all patients before gastrointestinal surgery. Modified Nickel’s bowel preparation was eliminated.
• A sterile dressing covered the incision for 24 to 48 hours after surgery. They also instituted tight glucose control, before, during, and after surgery.

“We are very much more cognizant now of the importance of controlling the blood sugar,” Routt noted. “This is an area that we continue to try to refine. There are a number of undiagnosed diabetics who come in for surgery, and they come in with very high blood sugars. We are doing a better job in the preoperative period of identifying these people. We start them on insulin drips in the operating room and continue that in the postoperative period because we found that the glucose control really helps reduce infections.”

Blood glucose was maintained perioperatively at less than 200 mg/dL in all patients.

In addition, patients were instructed to abstain from cigarette smoking or consuming tobacco products for at least 30 days before any elective surgery.

By the end of 6 months, these mea - sures had reduced surgical site infections by 18.6%, and by 12 months, by 19.2%. “That’s a great result. That’s a reduction by a fifth, so we were very pleased with that,” commented Parks.

“Since we’ve looked at these results we have identified other areas that need improvement so we are going to continue to refine our plan to try to reach our desired outcome, which is to be better than the other institutions that currently we are benchmarking ourselves against,” she added.