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4 ways to help reduce surgical site infections

Surgical site infections (SSI) are on the rise. What’s your plan to reduce SSI? Consider these four tips before you operate:

1 | Begin with the skin
2 | Tables take cover
3 | Beware the colonies
4 | Dress for success

Whether you’re doing total joint procedures today or plan to, it’s important for your staff to have the tools and knowledge to help prevent, diagnose and treat surgical site infections (SSI).

Surgical site infections are on the rise

1 | Begin with the skin

About 80% of skin flora occurs on the outside layers of the skin.1 In fact, one square centimeter of skin can host as many as 10 million aerobic bacteria, a leading cause of healthcare-acquired infections.2

Try a single-use skin prep applicator to help reduce skin flora. For example, BD’s ChloraPrep® Prep Solution with Tint moves the clinician’s hand away from the patient’s skin for a more aseptic technique.* The proprietary tinting process also allows the clinician to see the prepped area more clearly.

2 | Tables take cover

The Association of periOperative Registered Nurses (AORN) guidelines state that the sterile field – including tables – should be covered if not being used immediately.6 You can help significantly reduce the risk for contamination by covering even just portions of the sterile field that are not in active use.6

The American Journal of Infection Control recently published a study stating that covering sterile tables reduced bacterial contaminations at four and eight hours. The study also suggested that covered tables reduce the amount of bioburden that can collect on unused instruments.7

Are you covering your tables and stands? These new back table covers and mayo stand covers make it easy.

3 | Beware the colonies

Research suggests risk of SSI increases up to nine times due to nasal colonization of Staphylococcus aureus, presenting a big challenge in surgical settings.8

30% of people are already nasally colonized with S. aureus when they reach the OR.8

S. aureus, also known as MRSA, is the leading cause of SSI, and yet surgical settings don’t always include testing for this bacteria in their pre-op care.

Nasal swab tests allow you to detect and identify MRSA for better prevention and control. Scalable instrument models fit into a wide variety of testing environments, including surgery centers that are usually challenged for space.

You can trace 80% of wound infections to the patients’ own nasal flora.9

Proactive clinicians have modified their pre-op protocol to treat every surgical patient with a nasal iodine-saturated swab, often with favorable results.10 For example, the Portland VA eliminated SSI completely when they began swabbing every patient with povidone iodine two hours before surgery.9

In response to an uptick in S. aureus infections among total joint patients, TRIA Orthopedic Center in Bloomington, MN started a screening program that brought infections to a halt. Lori Groven, MSPHN, RN, CIC and infection preventionist with TRIA suggests placing an order for pre-op screenings as soon as the surgery is scheduled.10

Try easy-to-use PVP-iodine nasal swabsticks for a compelling long-term cost benefit. PDI Healthcare’s Profend™ can kill 99.7% of S. aureus at one hour and 99.9% at twelve hours, and takes just 60 seconds to apply, according to PDI.

4 | Dress for success

Not all orthopedic surgical gowns are created equal. When selecting a gown, be sure to choose one that’s resistant to tears, punctures, strikethrough and fiber strains.

High-quality surgical gowns should meet or exceed testing standards of the American National Standards Institute and the Association for the Advancement of Medical Instrumentation and should be certified to meet AAMI level 3 standards for all critical zones.

These gowns, for example, meet these rigorous standards and feature a cool-back panel for maximum comfort.

1 | READMISSION RATES, CAUSES, AND COSTS FOLLOWING TOTAL JOINT ARTHROPLASTY IN US MEDICARE POPULATION W. Murphy, P. Lane, B. Lin, T. Cheng, D. Terry, S. Murphy; Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468 (1):45-51.
2 | Kurtz SM, Lau E,Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8) (suppl):61-5.e1.
3 | Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-785
4 | Brown E, Wenzel RP, Hendley JO. Exploration of the microbial anatomy of normal human skin by using plasmid profiles of coagulasenegative staphylococci: search for the reservoir of resident skin flora. J Infect Dis. 1989;160(4):644-650.
5 | Hibbard JS. Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review. J Infus Nurs. 2005;28(3):194-207; Sievert D. Antimicrobial-resistant pathogens associated with healthcare associated infections: summary of data reported to the NHSN at the CDC, 2009-2010. Infect Control Hosp Epidemiol. 2013;34(1):1-14.
6 | AORN Guidelines for Perioperative Practice, 2018 Edition
7 | Markel, et al. Covering the instrument table decreases bioburden: An evaluation of environmental quality indicators, American Journal of Infection Control, 2018
8 | Price CS, Williams A, Philips G, Dayton M, Smith W, Morgan S. Staphylococcus aureus nasal colonization in preoperative orthopaedic outpatients. Clin Orthop Relat Res. 2008;466(11):2842-2847
9 | Melissa S. Schmidt, MSN, RN, CNL, CPAN, CAPA, PACU.; VandenBergh MF, Yzerman EP, van Belkum A, Boelens HA, Sijmons M, Verbrugh HA. Follow-up of Staphylococcus aureus nasal carriage after 8 years: redefining the persistent carrier state. J Clin Microbiol. 1999;37:3133-3140
10 | Outpatient Surgery, 2018

*Supported by clinical evidence from more than 50 peer-reviewed publications. Application process does not apply to swabstick format.

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